Provider Demographics
NPI:1093362667
Name:CARSON, CRYSTAL JUNE (MS; LPC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:JUNE
Last Name:CARSON
Suffix:
Gender:F
Credentials:MS; LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 KNOCK N KNOLL CIR
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1924
Mailing Address - Country:US
Mailing Address - Phone:215-272-3472
Mailing Address - Fax:
Practice Address - Street 1:503 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067
Practice Address - Country:US
Practice Address - Phone:215-497-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional