Provider Demographics
NPI:1699913921
Name:CONSONERY, CRYSTAL MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:MARIE
Last Name:CONSONERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2597 TWIN OAKS DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2531
Mailing Address - Country:US
Mailing Address - Phone:770-847-0112
Mailing Address - Fax:678-279-9943
Practice Address - Street 1:285 VICTORY DR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2303
Practice Address - Country:US
Practice Address - Phone:770-847-0112
Practice Address - Fax:678-279-9943
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor