Provider Demographics
NPI:1164845624
Name:ARMSTRONG, KRYSTAL LATRICE (MA LPC CADC)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:LATRICE
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:MA LPC CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CASS AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2252
Mailing Address - Country:US
Mailing Address - Phone:586-339-5744
Mailing Address - Fax:586-314-6375
Practice Address - Street 1:117 CASS AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2252
Practice Address - Country:US
Practice Address - Phone:586-339-5744
Practice Address - Fax:586-314-6375
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011876101Y00000X
MI2-01230101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)