Provider Demographics
NPI:1265118384
Name:LEWIS, CRYSTAL V (EDS, LPC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:V
Last Name:LEWIS
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 LEE RD 248
Mailing Address - Street 2:
Mailing Address - City:SMITHS STATION
Mailing Address - State:AL
Mailing Address - Zip Code:36877
Mailing Address - Country:US
Mailing Address - Phone:762-258-2249
Mailing Address - Fax:
Practice Address - Street 1:1568 SUMMERVILLE RD
Practice Address - Street 2:
Practice Address - City:SMITHS STATION
Practice Address - State:AL
Practice Address - Zip Code:36877-5009
Practice Address - Country:US
Practice Address - Phone:762-258-2249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPCC014017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional