Provider Demographics
NPI:1336488816
Name:MINTZ, CHRYSTAL MAY (CADC-CAS)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:MAY
Last Name:MINTZ
Suffix:
Gender:F
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7867 CONVOY CT
Mailing Address - Street 2:STE.-302
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1214
Mailing Address - Country:US
Mailing Address - Phone:858-277-4633
Mailing Address - Fax:858-277-4933
Practice Address - Street 1:7867 CONVOY CT
Practice Address - Street 2:STE.-302
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1214
Practice Address - Country:US
Practice Address - Phone:858-277-4633
Practice Address - Fax:858-277-4933
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)