Provider Demographics
NPI:1265532527
Name:BUSH, CRYSTAL D (LCSW, LCAS, LISW-CP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:D
Last Name:BUSH
Suffix:
Gender:F
Credentials:LCSW, LCAS, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MARIANNA PL
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7683
Mailing Address - Country:US
Mailing Address - Phone:984-292-4235
Mailing Address - Fax:888-245-5107
Practice Address - Street 1:1235 S SCALES ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5630
Practice Address - Country:US
Practice Address - Phone:199-539-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1615101YA0400X
SC1041C0700X
NCC0063581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCSS#OtherTRICARE
NC6007277Medicaid
NC156NMOtherBLUE CROSS BLUE SHIELD OF NORTH CAROLINA