Provider Demographics
NPI:1467230276
Name:MANNEY, CRYSTAL D (LLMSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:MANNEY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4656 CLAUDIA DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1100
Mailing Address - Country:US
Mailing Address - Phone:248-434-7638
Mailing Address - Fax:
Practice Address - Street 1:15173 NORTH RD STE 100
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1381
Practice Address - Country:US
Practice Address - Phone:810-258-9365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511159551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical