Provider Demographics
NPI:1538773692
Name:CRAWFORD, CHARHONDA CHELLISE
Entity type:Individual
Prefix:
First Name:CHARHONDA
Middle Name:CHELLISE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 HUFFMAN ST APT 18
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28098-1900
Mailing Address - Country:US
Mailing Address - Phone:704-421-6863
Mailing Address - Fax:
Practice Address - Street 1:214 HUFFMAN ST APT 18
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:NC
Practice Address - Zip Code:28098-1900
Practice Address - Country:US
Practice Address - Phone:704-421-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18105225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist