Provider Demographics
NPI:1881446680
Name:DACOSTA, CRYSTAL (LCMHC)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:DACOSTA
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 UNION ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-6132
Mailing Address - Country:US
Mailing Address - Phone:603-479-2984
Mailing Address - Fax:
Practice Address - Street 1:148 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3493
Practice Address - Country:US
Practice Address - Phone:603-689-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health