Provider Demographics
NPI:1497456594
Name:LANDTROOP, CRYSTAL RENEE (MA, NCC, LCMHCA)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:RENEE
Last Name:LANDTROOP
Suffix:
Gender:F
Credentials:MA, NCC, LCMHCA
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:RENEE
Other - Last Name:LANDTROOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:190 ROSEWOOD CENTRE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7628
Mailing Address - Country:US
Mailing Address - Phone:919-851-1527
Mailing Address - Fax:
Practice Address - Street 1:190 ROSEWOOD CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7628
Practice Address - Country:US
Practice Address - Phone:919-851-1527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18608101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health