Provider Demographics
NPI:1003541335
Name:DORSEY, CRYSTAL SHARRELL
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:SHARRELL
Last Name:DORSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4264 MARY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4319
Mailing Address - Country:US
Mailing Address - Phone:443-831-1284
Mailing Address - Fax:
Practice Address - Street 1:2700 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-3115
Practice Address - Country:US
Practice Address - Phone:667-600-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12636101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health