Provider Demographics
NPI:1023537776
Name:FLOYD-WILSON, CRYSTAL JOANN (LCSW-A)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:JOANN
Last Name:FLOYD-WILSON
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 HITCHCOCK DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-1945
Mailing Address - Country:US
Mailing Address - Phone:919-423-9135
Mailing Address - Fax:
Practice Address - Street 1:3201 YORKTOWN AVE STE 117D
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1474
Practice Address - Country:US
Practice Address - Phone:919-423-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty