Provider Demographics
NPI:1528504172
Name:CRAWLEY, DETRINA EVETTE
Entity type:Individual
Prefix:
First Name:DETRINA
Middle Name:EVETTE
Last Name:CRAWLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7524 HOLLYLEAF CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-2831
Mailing Address - Country:US
Mailing Address - Phone:804-245-9088
Mailing Address - Fax:
Practice Address - Street 1:7524 HOLLYLEAF CT
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-2831
Practice Address - Country:US
Practice Address - Phone:804-245-9088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9958101YP2500X
NC17471101YM0800X
VA717760101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health