Provider Demographics
NPI:1467135665
Name:CRASTO, CANDIDA (MFT-TRAINEE)
Entity Type:Individual
Prefix:
First Name:CANDIDA
Middle Name:
Last Name:CRASTO
Suffix:
Gender:F
Credentials:MFT-TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 DUTTON CT
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9267
Mailing Address - Country:US
Mailing Address - Phone:937-671-0502
Mailing Address - Fax:
Practice Address - Street 1:4555 LAKE FOREST DR STE 650
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-3789
Practice Address - Country:US
Practice Address - Phone:513-588-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM.2300343-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health