MEDICARE: MRS. KELSEY CROWE MSW, LCSW, LCAS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	3505	NC
2	1041C0700X	Clinical Social Worker	C009551	NC

General Provider Information

NPI Number	:	1881022176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELSEY CROWE MSW, LCSW, LCAS

Provider Business Mailing Address
First Line	:	127 E TRADE ST
Second Line	:
City	:	FOREST CITY
State	:	NC
Zip	:	28043-3131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 E TRADE ST
Second Line	:
City	:	FOREST CITY
State	:	NC
Zip	:	28043-3131
Country	:	US
Telephone Number	:	828-248-4403
Fax Number	:

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

Provider Enumeration Date	:	10/23/2013
Last Update Date	:	10/03/2015

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