Provider Demographics
NPI:1609078922
Name:HOWARD, EDITH CRYSTAL (LCSW)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:CRYSTAL
Last Name:HOWARD
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 1:6614 LATHERTON LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8025
Mailing Address - Country:US
Mailing Address - Phone:704-743-2126
Mailing Address - Fax:704-743-2130
Practice Address - Street 1:6614 LATHERTON LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-8025
Practice Address - Country:US
Practice Address - Phone:704-743-2126
Practice Address - Fax:704-743-2130
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0054171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical