Provider Demographics
NPI:1851153282
Name:IMES, CRYSTAL GUTIERREZ (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:GUTIERREZ
Last Name:IMES
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 S ELM EUGENE ST # 3109
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-2200
Mailing Address - Country:US
Mailing Address - Phone:336-365-2354
Mailing Address - Fax:
Practice Address - Street 1:1451 S ELM EUGENE ST # 3109
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-2200
Practice Address - Country:US
Practice Address - Phone:336-365-2354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0201661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical