Provider Demographics
NPI:1952775017
Name:BLAIR, CRYSTAL VECHLEKAR (MS, LCMHC, LCAS)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:VECHLEKAR
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MS, LCMHC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-2738
Mailing Address - Country:US
Mailing Address - Phone:336-770-3288
Mailing Address - Fax:
Practice Address - Street 1:1533 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-2738
Practice Address - Country:US
Practice Address - Phone:336-770-3288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22024101YA0400X
NC11903101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)