Provider Demographics
NPI:1174026710
Name:BURRELL, CRYSTAL N (LCMHC, LCAS)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:N
Last Name:BURRELL
Suffix:
Gender:F
Credentials:LCMHC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120C N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-3214
Mailing Address - Country:US
Mailing Address - Phone:828-270-9774
Mailing Address - Fax:
Practice Address - Street 1:120C N MAIN AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3214
Practice Address - Country:US
Practice Address - Phone:828-270-9774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24301101YA0400X
NCA13970101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional