=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861468795
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN B CRAWLEY PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 380 COPPERFIELD BLVD NE NE PSYCH
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28025-2402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-262-1800
-----------------------------------------------------
Fax | 704-262-1836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 380 COPPERFIELD BLVD NE NE PSYCH
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28025-2402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-262-1800
-----------------------------------------------------
Fax | 704-262-1836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 1690
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------