Provider Demographics
NPI:1225655244
Name:ALEXANDER, CRYSTAL (LMCHCA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LMCHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21300 CATAWBA AVE
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8505
Mailing Address - Country:US
Mailing Address - Phone:704-967-4100
Mailing Address - Fax:
Practice Address - Street 1:21300 CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8505
Practice Address - Country:US
Practice Address - Phone:704-967-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health