Basic Information
| Provider Information | |||||||||
| NPI: | 1689086431 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAWFORD | ||||||||
| FirstName: | COURTNEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 E CHAPEL HILL ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277013202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196887101 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2020 CHAPEL HILL RD STE 23 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277071186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196887101 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2014 | ||||||||
| LastUpdateDate: | 08/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P008794 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.