Provider Demographics
NPI:1003570813
Name:DAVIS-DUNN, KRYSTAL R
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:R
Last Name:DAVIS-DUNN
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 1:1200 WOLF CT
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1869
Mailing Address - Country:US
Mailing Address - Phone:734-985-8662
Mailing Address - Fax:
Practice Address - Street 1:601 ABBOT RD STE 103E
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3366
Practice Address - Country:US
Practice Address - Phone:517-574-4797
Practice Address - Fax:517-484-1771
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511105421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical