Provider Demographics
NPI:1417385568
Name:ROBERTS, CHRYSTAL ALEXANDRA NEWTON (LPC, LPCS)
Entity Type:Individual
Prefix:MRS
First Name:CHRYSTAL
Middle Name:ALEXANDRA NEWTON
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPC, LPCS
Other - Prefix:MRS
Other - First Name:CHRYSTAL
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:100 EXECUTIVE CENTER DRIVE
Mailing Address - Street 2:STE A11 #23042
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-8426
Mailing Address - Country:US
Mailing Address - Phone:864-430-6426
Mailing Address - Fax:864-435-9725
Practice Address - Street 1:100 EXECUTIVE CENTER DR STE A11
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-8426
Practice Address - Country:US
Practice Address - Phone:864-453-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid
SC301100Medicaid