Provider Demographics
NPI:1487024626
Name:DORTON, CRYSTAL SHARALD BESSIE
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:SHARALD BESSIE
Last Name:DORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44511 16TH ST E APT D
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-6339
Mailing Address - Country:US
Mailing Address - Phone:661-941-0658
Mailing Address - Fax:
Practice Address - Street 1:44511 16TH ST E APT D
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-6339
Practice Address - Country:US
Practice Address - Phone:661-941-0658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)