Provider Demographics
NPI:1316533326
Name:CRUTCHER, ANITA BALLENTINE
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:BALLENTINE
Last Name:CRUTCHER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 CHARLAND CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3941
Mailing Address - Country:US
Mailing Address - Phone:919-889-4356
Mailing Address - Fax:919-779-7285
Practice Address - Street 1:1308 CHARLAND CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3941
Practice Address - Country:US
Practice Address - Phone:919-889-4356
Practice Address - Fax:919-779-7285
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16178101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional