Provider Demographics
NPI:1235417775
Name:JONES, CRYSTAL NEWKIRK (LCSW, LISW-CP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:NEWKIRK
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 EDENHALL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7092
Mailing Address - Country:US
Mailing Address - Phone:919-368-2417
Mailing Address - Fax:
Practice Address - Street 1:160 MEDICAL CIR FL 1
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3639
Practice Address - Country:US
Practice Address - Phone:803-796-6811
Practice Address - Fax:803-796-6851
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0058551041C0700X
NCC0085991041C0700X
SC117891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1235417775Medicaid
SCSW1296Medicaid
NCQ51245Medicare PIN