Provider Demographics
NPI:1730731092
Name:CRENSHAW, MICHAEL SR (CHAPLAIN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CRENSHAW
Suffix:SR
Gender:M
Credentials:CHAPLAIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4668 LAUREL TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-7934
Mailing Address - Country:US
Mailing Address - Phone:252-324-2295
Mailing Address - Fax:
Practice Address - Street 1:4668 LAUREL TRAIL RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-7934
Practice Address - Country:US
Practice Address - Phone:252-314-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional