Provider Demographics
NPI:1316790462
Name:CREWS, PAUL WYNN I (LADACI)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:WYNN
Last Name:CREWS
Suffix:I
Gender:M
Credentials:LADACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 STATE ST
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2082
Mailing Address - Country:US
Mailing Address - Phone:615-645-1141
Mailing Address - Fax:
Practice Address - Street 1:250 STATE ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2082
Practice Address - Country:US
Practice Address - Phone:615-645-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1610101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)