Basic Information
| Provider Information | |||||||||
| NPI: | 1093220238 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAWFORD | ||||||||
| FirstName: | SHADARRIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1117 MARION HWY | ||||||||
| Address2: | |||||||||
| City: | FARMERVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712419313 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1117 MARION HWY | ||||||||
| Address2: | |||||||||
| City: | FARMERVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712419313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183682300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2017 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.