Provider Demographics
NPI:1619202041
Name:FAVRE, CRYSTAL LYNN (LPC007028, GEORGIA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LYNN
Last Name:FAVRE
Suffix:
Gender:F
Credentials:LPC007028, GEORGIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 ROCKY RIDGE PASS
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9751
Mailing Address - Country:US
Mailing Address - Phone:404-786-2040
Mailing Address - Fax:770-345-8801
Practice Address - Street 1:2404 REFUGE RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4946
Practice Address - Country:US
Practice Address - Phone:706-692-7209
Practice Address - Fax:706-693-0144
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor