Provider Demographics
NPI:1245525708
Name:O'BRIANT, CRYSTAL ST CLAIR (MSW, P-LCSW)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:ST CLAIR
Last Name:O'BRIANT
Suffix:
Gender:F
Credentials:MSW, P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 TIFFANY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1812
Mailing Address - Country:US
Mailing Address - Phone:252-443-9314
Mailing Address - Fax:
Practice Address - Street 1:805 TIFFANY BLVD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1812
Practice Address - Country:US
Practice Address - Phone:252-443-9314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0065801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical