Provider Demographics
NPI:1285007484
Name:JOSEPH, CRYSTAL (LC6912)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LC6912
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 SILVER SPRING AVE STE 401C
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4617
Mailing Address - Country:US
Mailing Address - Phone:240-398-3936
Mailing Address - Fax:301-576-5401
Practice Address - Street 1:817 SILVER SPRING AVE STE 401C
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4617
Practice Address - Country:US
Practice Address - Phone:240-398-3936
Practice Address - Fax:301-576-5401
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6912101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional