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General NPI Number Information
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NPI Number | 1982971263
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Entity Type | Individual
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Provider Name | MARY EMMA CRENSHAW LISW,LICDC
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Gender | Female
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 12395 MCCRACKEN RD STE A-UP
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-2967
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Country | US
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Telephone | 216-587-6727
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Fax |
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Provider Business Mailing Address
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Address Line | 5504 STATE RD
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City | PARMA
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State | OH
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Zip | 44134-2250
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Country | US
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Telephone | 216-773-2503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0600066
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 976149
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License Number State | OH
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