Provider Demographics
NPI:1871179127
Name:BOBBITT, CRYSTAL L (LMFTA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:BOBBITT
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 GOOSE BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-9158
Mailing Address - Country:US
Mailing Address - Phone:252-443-2308
Mailing Address - Fax:
Practice Address - Street 1:2747 SUNSET AVE STE 109
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3751
Practice Address - Country:US
Practice Address - Phone:252-985-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12294A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty