Provider Demographics
NPI:1881130052
Name:O'MARA, CRYSTAL (BCABA)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:O'MARA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:JERNIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3904 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6717
Mailing Address - Country:US
Mailing Address - Phone:910-313-3232
Mailing Address - Fax:910-313-6598
Practice Address - Street 1:3904 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6717
Practice Address - Country:US
Practice Address - Phone:910-313-3232
Practice Address - Fax:910-313-6598
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst