Provider Demographics
NPI:1780073791
Name:PARKER, CRYSTAL
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:RANDOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:3018 WOODHOME AVE
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-7808
Mailing Address - Country:US
Mailing Address - Phone:443-869-6185
Mailing Address - Fax:
Practice Address - Street 1:3018 WOODHOME AVE
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-7808
Practice Address - Country:US
Practice Address - Phone:443-869-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD168261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical