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General NPI Number Information
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NPI Number | 1841555745
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Entity Type | Organization
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Legal Business Name | CHRISTA L CRAWFORD LCSW PC
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Dates
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Enumeration Date | 07/08/2012
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 2914 N OAK ST
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City | VALDOSTA
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State | GA
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Zip | 31602-1718
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Country | US
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Telephone | 229-333-0300
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Fax | 229-333-0306
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Provider Business Mailing Address
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Address Line | 3012 ASBURY CIR
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City | VALDOSTA
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State | GA
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Zip | 31602-1455
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Country | US
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Telephone | 229-292-4103
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTA L CRAWFORD
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Credential | LCSW
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Telephone | 229-292-4103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003454
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License Number State | GA
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