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NPI Code Detail

MEDICARE: IMANI SIMONE CRAWFORD LCSWA

MEDICARE: IMANI SIMONE CRAWFORD LCSWA
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
11041C0700XClinical Social WorkerP015969NC

General Provider Information

NPI Number : 1336728864
Entity Type Code : Individual
Provider Name (Legal Business Name) : IMANI SIMONE CRAWFORD LCSWA
Provider Business Mailing Address
First Line : 3252 SUMMERCROFT LN
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-2226
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10700 SIKES PL STE 325
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-8208
Country : US
Telephone Number : 704-420-0288
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2021
Last Update Date : 04/02/2021

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Directions to “ IMANI SIMONE CRAWFORD LCSWA” Practice Location

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