Provider Demographics
NPI:1972959252
Name:WATKINS, CRYSTAL (MS, LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MS, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BRUTON ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3767
Mailing Address - Country:US
Mailing Address - Phone:478-320-1576
Mailing Address - Fax:
Practice Address - Street 1:315 W PONCE DE LEON AVE STE 546
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2448
Practice Address - Country:US
Practice Address - Phone:478-320-1576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008807101YP2500X
NY9113551101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional