Provider Demographics
NPI:1386946457
Name:CRESPO, LAURIE-ANNE (LICSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAURIE-ANNE
Middle Name:
Last Name:CRESPO
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:MS
Other - First Name:LAURIE-ANNE
Other - Middle Name:
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW, LCSW
Mailing Address - Street 1:1956 UNIVERSITY BLVD SOUTH
Mailing Address - Street 2:SUITE J-297
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609
Mailing Address - Country:US
Mailing Address - Phone:251-268-9944
Mailing Address - Fax:251-706-5596
Practice Address - Street 1:9520 HAMILTON CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695
Practice Address - Country:US
Practice Address - Phone:251-268-9944
Practice Address - Fax:251-450-5596
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLICSW3993C1041C0700X
FLLCSWSW91391041C0700X
FLSW91391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005575300Medicaid