Provider Demographics
NPI:1689085540
Name:PERRY, CRYSTAL MICHELLE
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:MICHELLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 GREENSPAN WAY
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-9528
Mailing Address - Country:US
Mailing Address - Phone:478-442-0701
Mailing Address - Fax:
Practice Address - Street 1:125 GREENSPAN WAY
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-9528
Practice Address - Country:US
Practice Address - Phone:478-442-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor