Provider Demographics
NPI:1609182328
Name:STANLEY, KRYSTAL (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 MASSACHUSETTS AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-4604
Mailing Address - Country:US
Mailing Address - Phone:202-341-0500
Mailing Address - Fax:877-637-7491
Practice Address - Street 1:1115 MASSACHUSETTS AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4604
Practice Address - Country:US
Practice Address - Phone:202-341-0500
Practice Address - Fax:877-637-7491
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000629103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist