Provider Demographics
NPI:1649896358
Name:DUSSIA, CRYSTAL ANN (LMSW)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:DUSSIA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2336
Mailing Address - Country:US
Mailing Address - Phone:313-324-8900
Mailing Address - Fax:313-324-8701
Practice Address - Street 1:1145 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2336
Practice Address - Country:US
Practice Address - Phone:313-324-8900
Practice Address - Fax:313-324-8701
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011040671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical