Provider Demographics
NPI:1427176296
Name:SMALL, CRYSTAL JAVAN (MA)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:JAVAN
Last Name:SMALL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 MERRION PARK LN
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6317
Mailing Address - Country:US
Mailing Address - Phone:919-491-0511
Mailing Address - Fax:
Practice Address - Street 1:1000 CORPORATE DR
Practice Address - Street 2:401
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8535
Practice Address - Country:US
Practice Address - Phone:919-643-5500
Practice Address - Fax:919-643-5550
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health