Provider Demographics
NPI:1811252083
Name:PETERSON BARKER, CRYSTAL (MS)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:PETERSON BARKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 BELCHER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MEADOWS OF DAN
Mailing Address - State:VA
Mailing Address - Zip Code:24120-3672
Mailing Address - Country:US
Mailing Address - Phone:540-840-9285
Mailing Address - Fax:540-242-0742
Practice Address - Street 1:1641 BELCHER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MEADOWS OF DAN
Practice Address - State:VA
Practice Address - Zip Code:24120-3672
Practice Address - Country:US
Practice Address - Phone:540-840-9285
Practice Address - Fax:540-840-9285
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst