Provider Demographics
NPI:1770882490
Name:STANLEY, CRYSTAL MONIQUE (CSW)
Entity type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:MONIQUE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ROBINHOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5754
Mailing Address - Country:US
Mailing Address - Phone:985-543-4800
Mailing Address - Fax:
Practice Address - Street 1:130 ROBINHOOD DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5754
Practice Address - Country:US
Practice Address - Phone:985-543-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA110921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical