Basic Information
| Provider Information | |||||||||
| NPI: | 1881336584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CREWS | ||||||||
| FirstName: | SHANE | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1007 MARY ST | ||||||||
| Address2: | |||||||||
| City: | WAYCROSS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315033823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124497100 | ||||||||
| FaxNumber: | 9124497060 | ||||||||
| Practice Location | |||||||||
| Address1: | 434 BRYAN ST | ||||||||
| Address2: | |||||||||
| City: | NAHUNTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315534964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124625849 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2022 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.