Provider Demographics
NPI:1487823688
Name:KNIGHT, CRYSTAL ALISA (LCSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ALISA
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BENT TREE DR
Mailing Address - Street 2:#50
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1195
Mailing Address - Country:US
Mailing Address - Phone:904-616-8499
Mailing Address - Fax:
Practice Address - Street 1:160 N BEACH ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3314
Practice Address - Country:US
Practice Address - Phone:386-944-4707
Practice Address - Fax:386-868-2569
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW83231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical