Basic Information
| Provider Information | |||||||||
| NPI: | 1437876612 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAWLEY | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | MELIA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LAPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 182 | ||||||||
| Address2: | |||||||||
| City: | SCOTTDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300790182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787772253 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 175 GWINNETT DR | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300468444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782092394 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2022 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 007530 | GA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.