Provider Demographics
NPI:1629364203
Name:STIDUM, CRYSTAL ROCHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ROCHELLE
Last Name:STIDUM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9214 TALL TIMBER BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8523
Mailing Address - Country:US
Mailing Address - Phone:501-247-0252
Mailing Address - Fax:012-470-2525
Practice Address - Street 1:217 W 2ND ST STE 306
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2522
Practice Address - Country:US
Practice Address - Phone:501-247-0252
Practice Address - Fax:501-712-4534
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health