Provider Demographics
NPI:1245000975
Name:WHITE, CRYSTAL DARMIKA
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DARMIKA
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 BRINKLEY RD APT 201
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-6150
Mailing Address - Country:US
Mailing Address - Phone:240-353-9181
Mailing Address - Fax:
Practice Address - Street 1:3035 BRINKLEY RD APT 201
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-6150
Practice Address - Country:US
Practice Address - Phone:240-353-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1047015163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health