Provider Demographics
NPI:1609470780
Name:DANIELS, CRYSTAL LUCILE (PSYD, FNP, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:LUCILE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PSYD, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9091 SNOWDEN RIVER PKWY # 1091
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1657
Mailing Address - Country:US
Mailing Address - Phone:443-383-3630
Mailing Address - Fax:
Practice Address - Street 1:100 WEST RD STE 300
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2370
Practice Address - Country:US
Practice Address - Phone:443-383-3630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06730103T00000X
MDR217915363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner