Provider Demographics
NPI:1265903306
Name:CRYSTAL, DANIELLE (LGPC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:CRYSTAL
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E JOPPA RD STE 407
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3109
Mailing Address - Country:US
Mailing Address - Phone:410-828-6262
Mailing Address - Fax:
Practice Address - Street 1:200 E JOPPA RD STE 407
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3109
Practice Address - Country:US
Practice Address - Phone:410-828-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9685101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGP9685OtherLGPC