Provider Demographics
NPI:1003205121
Name:FLETCHER, CRYSTA (LISW)
Entity Type:Individual
Prefix:
First Name:CRYSTA
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:CRYSTA
Other - Middle Name:
Other - Last Name:LOVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4760 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-1426
Mailing Address - Country:US
Mailing Address - Phone:513-861-0035
Mailing Address - Fax:
Practice Address - Street 1:3284 NORTH BEND RD
Practice Address - Street 2:SUITE 314
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-7688
Practice Address - Country:US
Practice Address - Phone:513-481-2432
Practice Address - Fax:513-662-2432
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI10001151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical