Provider Demographics
NPI:1275079493
Name:AGEE-THOMAS, CRYSTAL (MSACE)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:AGEE-THOMAS
Suffix:
Gender:F
Credentials:MSACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:GROVE HILL
Mailing Address - State:AL
Mailing Address - Zip Code:36451-3050
Mailing Address - Country:US
Mailing Address - Phone:251-275-4165
Mailing Address - Fax:251-275-4807
Practice Address - Street 1:129 CLARK ST
Practice Address - Street 2:
Practice Address - City:GROVE HILL
Practice Address - State:AL
Practice Address - Zip Code:36451-3050
Practice Address - Country:US
Practice Address - Phone:251-275-4165
Practice Address - Fax:251-275-4807
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health