Provider Demographics
NPI:1871928754
Name:CRUDUP, DEONDRA DENISE (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEONDRA
Middle Name:DENISE
Last Name:CRUDUP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 GREENHOUSE ST
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-5546
Mailing Address - Country:US
Mailing Address - Phone:919-748-7048
Mailing Address - Fax:
Practice Address - Street 1:8396 SIX FORKS RD STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3058
Practice Address - Country:US
Practice Address - Phone:919-576-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0084391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical