Provider Demographics
NPI:1366424566
Name:CRENSHAW, CLAUDIA (RN,PHD,APRN,LPC)
Entity type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:RN,PHD,APRN,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WEST PONCE DE LEON AVE
Mailing Address - Street 2:SUITE 540
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030
Mailing Address - Country:US
Mailing Address - Phone:404-403-2669
Mailing Address - Fax:404-373-7647
Practice Address - Street 1:315 WEST PONCE DE LEON AVE
Practice Address - Street 2:SUITE 540
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:404-403-2669
Practice Address - Fax:404-373-7647
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1115101YA0400X, 101YM0800X
GARN052883364SP0808X, 364SP0809X, 364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Geropsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582355339OtherFEDERAL TAX ID NUMBER