MEDICARE: ANITA BALLENTINE CRUTCHER

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	101YP2500X	Professional Counselor	16178	NC

General Provider Information

NPI Number	:	1316533326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA BALLENTINE CRUTCHER

Provider Business Mailing Address
First Line	:	1308 CHARLAND CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-3941
Country	:	US
Telephone Number	:	919-889-4356
Fax Number	:	919-779-7285

Provider Business Practice Location Address
First Line	:	1308 CHARLAND CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-3941
Country	:	US
Telephone Number	:	919-889-4356
Fax Number	:	919-779-7285

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

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	03/18/2025

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