Provider Demographics
NPI:1740634435
Name:ROFKAHR, CRYSTAL SUSAN (PHD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:SUSAN
Last Name:ROFKAHR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-0064
Mailing Address - Country:US
Mailing Address - Phone:479-435-6259
Mailing Address - Fax:479-435-6276
Practice Address - Street 1:26 E MEADOW ST STE 3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:479-435-6259
Practice Address - Fax:479-435-6276
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16-08P103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling