Provider Demographics
NPI:1235312430
Name:ANDERSON-AKINS, CRYSTAL (LMSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:ANDERSON-AKINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2809 FOREST HOME RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5320
Mailing Address - Country:US
Mailing Address - Phone:866-972-1268
Mailing Address - Fax:
Practice Address - Street 1:1719 MERRILL DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4009
Practice Address - Country:US
Practice Address - Phone:501-663-2199
Practice Address - Fax:501-663-2234
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2664-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR170512795Medicaid