Provider Demographics
NPI:1851946891
Name:DEWOLF, CHRYSTAL MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:MARIE
Last Name:DEWOLF
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CHRYSTAL
Other - Middle Name:MARIE
Other - Last Name:HOOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4709 MOUNT BRIAR RD
Mailing Address - Street 2:
Mailing Address - City:KEEDYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21756-1511
Mailing Address - Country:US
Mailing Address - Phone:443-691-8813
Mailing Address - Fax:
Practice Address - Street 1:8504 MAPLEVILLE RD
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-1817
Practice Address - Country:US
Practice Address - Phone:301-733-9067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9662101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health