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Individual

CARRIE JO CRANDALL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
315 N WEBER ST, COLORADO SPRINGS, CO 80903-1230
(630) 204-2533
Mailing address
315 N WEBER ST, COLORADO SPRINGS, CO 80903-1230
(630) 204-2533

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
178005010
IL
101YP2500X
Professional Counselor
Primary
0011278
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0011278
COLORADO STATE LPC
CO
01
178005010
STATE LICENSE
IL
01
2006 522
ILLINOIS LICENSED DOMESTIC VIOLENCE COUNSELOR - ICDVP
IL
Enumeration date
06/14/2007
Last updated
03/24/2013
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