Provider Demographics
NPI:1093937146
Name:COLLINS, CRYSTAL N (LCSWC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:N
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 FORBES BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4342
Mailing Address - Country:US
Mailing Address - Phone:301-533-7667
Mailing Address - Fax:
Practice Address - Street 1:8221 WILLOW OAKS CORPORATE DR # 4420
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4512
Practice Address - Country:US
Practice Address - Phone:571-623-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD192901041C0700X
DCLC500799571041C0700X
VA09040156691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0960861 00Medicaid
MD941L70Medicare ID - Type Unspecified