Provider Demographics
NPI:1285946137
Name:HINER, CRYSTAL D (PCCS/ LICDC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:HINER
Suffix:
Gender:F
Credentials:PCCS/ LICDC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:D
Other - Last Name:OSTROWSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCCS/LICDC
Mailing Address - Street 1:3575 FOREST LAKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8115
Mailing Address - Country:US
Mailing Address - Phone:330-949-7043
Mailing Address - Fax:
Practice Address - Street 1:3575 FOREST LAKE DR STE 100
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8115
Practice Address - Country:US
Practice Address - Phone:330-949-7043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0900175SUPV101YP2500X, 101YM0800X
OHLICDC 111039101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE0900175 SUPVOtherPCCS
OHLICDC 111039OtherLICDC