Provider Demographics
NPI:1255965869
Name:MONNIN, CRYSTAL ASHLEY (LLMSW)
Entity type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:ASHLEY
Last Name:MONNIN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:ASHLEY
Other - Last Name:WILLOCKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16244 MERSON CT
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:MI
Mailing Address - Zip Code:49107-9455
Mailing Address - Country:US
Mailing Address - Phone:574-276-3427
Mailing Address - Fax:
Practice Address - Street 1:109 N 3RD ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2655
Practice Address - Country:US
Practice Address - Phone:269-683-8972
Practice Address - Fax:269-683-0449
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011065271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical