Provider Demographics
NPI:1285190686
Name:WHITTINGTON, CRYSTAL (LAC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:WHITTINGTON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 W BEEBE CAPPS EXPY
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5169
Mailing Address - Country:US
Mailing Address - Phone:501-279-9220
Mailing Address - Fax:501-279-9450
Practice Address - Street 1:1554 W BEEBE CAPPS EXPY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-5169
Practice Address - Country:US
Practice Address - Phone:501-279-9220
Practice Address - Fax:501-279-9450
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ARA2105010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator