Provider Demographics
NPI:1487147385
Name:DIXON-VALENTINE, CRYSTAL NICOLE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:NICOLE
Last Name:DIXON-VALENTINE
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 1:3185 RINGGOLD DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24594-2003
Mailing Address - Country:US
Mailing Address - Phone:434-632-5993
Mailing Address - Fax:
Practice Address - Street 1:693 LEESVILLE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2828
Practice Address - Country:US
Practice Address - Phone:434-942-4902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician