Provider Demographics
NPI:1841608312
Name:HURNDON, CRYSTAL R (LCSW-C, LICSW)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:R
Last Name:HURNDON
Suffix:
Gender:F
Credentials:LCSW-C, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 VARNUM ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20722-1345
Mailing Address - Country:US
Mailing Address - Phone:202-247-1540
Mailing Address - Fax:
Practice Address - Street 1:10410 KENSINGTON PKWY
Practice Address - Street 2:SUITE 221
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2943
Practice Address - Country:US
Practice Address - Phone:202-247-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD114911041C0700X
DCLC3032551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical