Provider Demographics
NPI:1992546089
Name:CRAWFORD, SHANNON (CADC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 SQUIRE CT SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-8604
Mailing Address - Country:US
Mailing Address - Phone:252-230-1262
Mailing Address - Fax:
Practice Address - Street 1:2500 SQUIRE CT SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8604
Practice Address - Country:US
Practice Address - Phone:252-230-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30463101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)