Provider Demographics
NPI:1902427495
Name:CRAWFORD, LANCE (LPC)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CHURCH AVE SW APT 303
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-2011
Mailing Address - Country:US
Mailing Address - Phone:540-688-8066
Mailing Address - Fax:
Practice Address - Street 1:123 NW 12TH AVE APT 434
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-4146
Practice Address - Country:US
Practice Address - Phone:540-688-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health