Provider Demographics
NPI:1053517342
Name:CRAWLEY-BUCKHOLTZ, KAREN IRENE (MA, LCPC)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:IRENE
Last Name:CRAWLEY-BUCKHOLTZ
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 SAPPINGTON DR
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1057
Mailing Address - Country:US
Mailing Address - Phone:443-351-2004
Mailing Address - Fax:
Practice Address - Street 1:1113 ODENTON RD
Practice Address - Street 2:SUITE 2D
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1606
Practice Address - Country:US
Practice Address - Phone:443-351-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional