Provider Demographics
NPI:1760991038
Name:DEBERRY, CRYSTAL DINESSE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:DINESSE
Last Name:DEBERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 AMERICAN WAY STE 200G
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-2471
Mailing Address - Country:US
Mailing Address - Phone:901-417-7297
Mailing Address - Fax:
Practice Address - Street 1:4821 AMERICAN WAY STE 200G
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2471
Practice Address - Country:US
Practice Address - Phone:901-417-7297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN79961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical