Provider Demographics
NPI:1023806023
Name:PENLAND, CRYSTAL RENEE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:RENEE
Last Name:PENLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CHARLES WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-7014
Mailing Address - Country:US
Mailing Address - Phone:828-237-5389
Mailing Address - Fax:
Practice Address - Street 1:310A BRATTON DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7827
Practice Address - Country:US
Practice Address - Phone:919-873-3441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician