Provider Demographics
NPI:1083954986
Name:CONDRY, CRYSTAL KOLB (LGSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:KOLB
Last Name:CONDRY
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12502 WILLOWBROOK ROAD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6592
Mailing Address - Country:US
Mailing Address - Phone:240-964-8585
Mailing Address - Fax:240-964-8586
Practice Address - Street 1:12502 WILLOWBROOK ROAD
Practice Address - Street 2:SUITE 380
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6592
Practice Address - Country:US
Practice Address - Phone:240-964-8585
Practice Address - Fax:240-964-8586
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19624104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker