Provider Demographics
NPI:1427628080
Name:CONEY, CRYSTAL (LMSW)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:CONEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W ROBINSON DR # 172
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:GA
Mailing Address - Zip Code:30445-2935
Mailing Address - Country:US
Mailing Address - Phone:912-583-0100
Mailing Address - Fax:912-583-0115
Practice Address - Street 1:421 W ROBINSON DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:GA
Practice Address - Zip Code:30445-2935
Practice Address - Country:US
Practice Address - Phone:912-583-0100
Practice Address - Fax:912-583-0115
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YP2500X
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty