Provider Demographics
NPI:1639603806
Name:COLLINS, CRYSTAL LEIGH (MS, RDN, LDN)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:LEIGH
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:MS
Other - First Name:CRYSTAL
Other - Middle Name:LEIGH
Other - Last Name:MCVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, LDN
Mailing Address - Street 1:1704 BETTY ST SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4634
Mailing Address - Country:US
Mailing Address - Phone:205-249-3841
Mailing Address - Fax:256-560-6265
Practice Address - Street 1:300 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1268
Practice Address - Country:US
Practice Address - Phone:256-974-1146
Practice Address - Fax:256-560-6265
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1541133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered