1114233301 NPI number — MS. JACQUELINE MILLICAN CRABB LCSW, LCAS, CCS

Table of content: MS. JACQUELINE MILLICAN CRABB LCSW, LCAS, CCS (NPI 1114233301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114233301 NPI number — MS. JACQUELINE MILLICAN CRABB LCSW, LCAS, CCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRABB
Provider First Name:
JACQUELINE
Provider Middle Name:
MILLICAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LCAS, CCS
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:
1114233301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1129 JUNIPER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28146-7816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-319-1532
Provider Business Mailing Address Fax Number:
704-255-1801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 CRESCENT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKWELL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28138-7515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-279-5556
Provider Business Practice Location Address Fax Number:
704-279-5439
Provider Enumeration Date:
08/25/2010

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: 1041C0700X , with the licence number:  C008033 , 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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