Provider Demographics
NPI:1134508492
Name:COSBY, CRYSTAL WHITNEY (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:WHITNEY
Last Name:COSBY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MS
Other - First Name:CRYSTAL
Other - Middle Name:WHITNEY
Other - Last Name:FESKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLBSW, LLMSW
Mailing Address - Street 1:8623 N WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1137
Mailing Address - Country:US
Mailing Address - Phone:734-367-0469
Mailing Address - Fax:
Practice Address - Street 1:8623 N WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1137
Practice Address - Country:US
Practice Address - Phone:734-367-0469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1134508492Medicaid