Provider Demographics
NPI:1235702861
Name:KING, CRYSTAL
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11949 ORAL OAKS RD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23974-2713
Mailing Address - Country:US
Mailing Address - Phone:804-316-5996
Mailing Address - Fax:
Practice Address - Street 1:11949 ORAL OAKS RD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:VA
Practice Address - Zip Code:23974-2713
Practice Address - Country:US
Practice Address - Phone:434-637-5755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management