Provider Demographics
NPI:1649228313
Name:WHITTINGTON, CRYSTAL ELAINE (MA)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:ELAINE
Last Name:WHITTINGTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 MARKET RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-7116
Mailing Address - Country:US
Mailing Address - Phone:304-254-9003
Mailing Address - Fax:304-254-9005
Practice Address - Street 1:313 MARKET RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-7116
Practice Address - Country:US
Practice Address - Phone:304-254-9003
Practice Address - Fax:304-254-9005
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV435103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WH0714834Medicare UPIN