1619246238 NPI number — MRS. LATRESHA ARTIS CRUMPLER LCSW

Table of content: MRS. LATRESHA ARTIS CRUMPLER LCSW (NPI 1619246238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619246238 NPI number — MRS. LATRESHA ARTIS CRUMPLER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUMPLER
Provider First Name:
LATRESHA
Provider Middle Name:
ARTIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619246238
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1202 E. FIRETOWER ROAD
Provider Second Line Business Mailing Address:
PATHWAYS TO LIFE, INC.
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27858-4196
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-695-0269
Provider Business Mailing Address Fax Number:
252-413-0526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1329 N. BRIGHTLEAF BLVD., SUITE A-1
Provider Second Line Business Practice Location Address:
PATHWAYS TO LIFE, INC.
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27577-7262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-938-0442
Provider Business Practice Location Address Fax Number:
919-938-0448
Provider Enumeration Date:
12/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  P006802 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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