Provider Demographics
NPI:1588380273
Name:MCCALL, CRYSTAL C (LPC-A)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:C
Last Name:MCCALL
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6078
Mailing Address - Country:US
Mailing Address - Phone:843-900-4236
Mailing Address - Fax:
Practice Address - Street 1:105 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6078
Practice Address - Country:US
Practice Address - Phone:843-900-4236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8052101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional