Provider Demographics
NPI:1962769778
Name:CRYSTAL CLEAR COUNSELING AND CONSULATIONS
Entity type:Organization
Organization Name:CRYSTAL CLEAR COUNSELING AND CONSULATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:J. CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:704-506-9635
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-0237
Mailing Address - Country:US
Mailing Address - Phone:704-506-9635
Mailing Address - Fax:
Practice Address - Street 1:8236 DEER DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-9682
Practice Address - Country:US
Practice Address - Phone:704-506-9635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1077648251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health