Provider Demographics
NPI:1174173553
Name:WHETSTONE, CRYSTAL NICOLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:NICOLE
Last Name:WHETSTONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 S HOUSTON LAKE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9027
Mailing Address - Country:US
Mailing Address - Phone:478-217-5924
Mailing Address - Fax:478-216-3437
Practice Address - Street 1:524 S HOUSTON LAKE RD STE 100
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9027
Practice Address - Country:US
Practice Address - Phone:478-217-5924
Practice Address - Fax:478-216-3437
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0081601041C0700X
GAMSW008535104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker