Provider Demographics
NPI:1215660816
Name:JOYCE, CRYSTAL S (CHW)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:S
Last Name:JOYCE
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:SHAREE
Other - Last Name:JOYCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MEDICAL ASSISTANT
Mailing Address - Street 1:421 S HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5258
Mailing Address - Country:US
Mailing Address - Phone:734-658-4670
Mailing Address - Fax:
Practice Address - Street 1:2700 HAMLIN BLVD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2206
Practice Address - Country:US
Practice Address - Phone:248-373-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
MI1-07-3468106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No172V00000XOther Service ProvidersCommunity Health Worker