Provider Demographics
NPI:1548799166
Name:MULLEN-JOHNSON, CRYSTAL ELAINE (LICSW, PIP,)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:ELAINE
Last Name:MULLEN-JOHNSON
Suffix:
Gender:F
Credentials:LICSW, PIP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35206-1616
Mailing Address - Country:US
Mailing Address - Phone:205-913-6078
Mailing Address - Fax:
Practice Address - Street 1:2024 3RD AVE N STE 312
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-3302
Practice Address - Country:US
Practice Address - Phone:205-721-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1332-3980C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical