MEDICARE: RACHEL DANE CRAWFORD ATR-BC, LCMHC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	13425	NC

General Provider Information

NPI Number	:	1245888502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL DANE CRAWFORD ATR-BC, LCMHC, NCC

Provider Business Mailing Address
First Line	:	3404 ROYDEN PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-1111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6813 FAIRVIEW RD STE C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3364
Country	:	US
Telephone Number	:	980-428-6195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	01/05/2024

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