Provider Demographics
NPI:1760617468
Name:DAYTON, KRYSTAL LAURA (MSW,CSW)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:LAURA
Last Name:DAYTON
Suffix:
Gender:F
Credentials:MSW,CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 SOUTH BALDWIN ROAD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348
Mailing Address - Country:US
Mailing Address - Phone:248-730-2715
Mailing Address - Fax:
Practice Address - Street 1:1520 S LAPEER RD
Practice Address - Street 2:STE. 216
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1454
Practice Address - Country:US
Practice Address - Phone:248-730-2715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-25
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010676441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical