Provider Demographics
NPI:1962288191
Name:CRAWFORD, JUSTIN JAMES
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:JAMES
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2849 MERRITTS MILL RD
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-6312
Mailing Address - Country:US
Mailing Address - Phone:850-272-0686
Mailing Address - Fax:
Practice Address - Street 1:2849 MERRITTS MILL RD
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-6312
Practice Address - Country:US
Practice Address - Phone:850-272-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach