Provider Demographics
NPI:1811676752
Name:COLUMBIA, CRYSTAL DIANE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DIANE
Last Name:COLUMBIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 BRIDGETON RD
Mailing Address - Street 2:
Mailing Address - City:FAWN GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17321-9320
Mailing Address - Country:US
Mailing Address - Phone:443-417-4800
Mailing Address - Fax:
Practice Address - Street 1:1171 BRIDGETON RD
Practice Address - Street 2:
Practice Address - City:FAWN GROVE
Practice Address - State:PA
Practice Address - Zip Code:17321-9320
Practice Address - Country:US
Practice Address - Phone:443-417-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No174H00000XOther Service ProvidersHealth Educator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst