Provider Demographics
NPI:1891847489
Name:BURKE, CRYSTAL E (LCSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:E
Last Name:BURKE
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:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:VA
Mailing Address - Zip Code:24283-0900
Mailing Address - Country:US
Mailing Address - Phone:276-762-0770
Mailing Address - Fax:276-762-0678
Practice Address - Street 1:HWY 63 NORTH
Practice Address - Street 2:CLINIC STREET
Practice Address - City:ST. PAUL
Practice Address - State:VA
Practice Address - Zip Code:24283
Practice Address - Country:US
Practice Address - Phone:276-762-0770
Practice Address - Fax:276-762-0678
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040048351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical