Provider Demographics
NPI:1548603848
Name:SMITH, CRYSTAL M
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:SMITH
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 1:1226 ROYAL DR SW STE I
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5926
Mailing Address - Country:US
Mailing Address - Phone:470-315-0114
Mailing Address - Fax:833-211-4852
Practice Address - Street 1:1226 ROYAL DR SW STE I
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5926
Practice Address - Country:US
Practice Address - Phone:470-315-0114
Practice Address - Fax:833-211-4852
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health