Provider Demographics
NPI:1801239751
Name:DANIELS, CRYSTAL EVON (LPCA)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:EVON
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 JUDY PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-6678
Mailing Address - Country:US
Mailing Address - Phone:919-581-9939
Mailing Address - Fax:
Practice Address - Street 1:110 SW CENTER ST
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-2124
Practice Address - Country:US
Practice Address - Phone:919-635-3344
Practice Address - Fax:919-635-3388
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9027101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional