Provider Demographics
NPI:1811772254
Name:SOLOMON, CRYSTAL SUE LUCKETT (LPC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:SUE LUCKETT
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 TURTLE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-5443
Mailing Address - Country:US
Mailing Address - Phone:434-532-5522
Mailing Address - Fax:
Practice Address - Street 1:20 W BANK ST STE 6
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3279
Practice Address - Country:US
Practice Address - Phone:804-862-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional