Individual provider Active NPI

Elaine Sharon Crummett, L.P.A., L.P.C.

  • Clinical Psychologist
  • Statesville, NC
National Provider Identifier
1245347335
Registry record updated Nov 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1443 Issued in NC
Practice address
1706 Davie Ave
Suite D
Statesville, NC 28677-3589
Phone
(704) 880-2384
Fax
(704) 873-7789
NPI assigned
Aug 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 3287 NC
Clinical Psychologist 103TC0700X 1443 NC Primary

Addresses

Primary practice location

1706 Davie Ave
Suite D
Statesville, NC 28677-3589

Mailing address

1706 Davie Ave
Suite D
Statesville, NC 28677-3589
Phone (704) 880-2384

Other identifiers 1

IdentifierTypeStateIssuer
11856OtherNCBC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1443NCMDClinical Psychologist
3287NCMDChiropractor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384387200000",
    "number": "1245347335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 DAVIE AVE",
            "address_2": "SUITE D",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773589",
            "telephone_number": "704-880-2384",
            "fax_number": "704-873-7789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 DAVIE AVE",
            "address_2": "SUITE D",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773589",
            "telephone_number": "704-880-2384",
            "fax_number": "704-873-7789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUMMETT",
        "first_name": "ELAINE",
        "middle_name": "SHARON",
        "name_prefix": "Ms.",
        "credential": "L.P.A., L.P.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2013-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "3287",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "1443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "11856",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.