Provider Demographics
NPI:1518445204
Name:LESTER-LEWIS, CRYSTAL (BS QMHP RPRS CSAC-A)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:LESTER-LEWIS
Suffix:
Gender:F
Credentials:BS QMHP RPRS CSAC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 MYLAN RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2273
Mailing Address - Country:US
Mailing Address - Phone:804-767-9723
Mailing Address - Fax:
Practice Address - Street 1:4325 MYLAN RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2273
Practice Address - Country:US
Practice Address - Phone:804-767-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0711000285101YA0400X
VA0735000015175T00000X
VA0732000133251B00000X, 251E00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health