Provider Demographics
NPI:1821857699
Name:CHAFIN, CRYSTAL
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:CHAFIN
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 1:111 TOWN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-9622
Mailing Address - Country:US
Mailing Address - Phone:276-963-3554
Mailing Address - Fax:276-963-4802
Practice Address - Street 1:111 TOWN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-9622
Practice Address - Country:US
Practice Address - Phone:276-963-3554
Practice Address - Fax:276-963-4802
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0709025442101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)