Provider Demographics
NPI:1962952226
Name:PRESTIA, CRYSTAL (LCSW, CAP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:PRESTIA
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N HIATUS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3094
Mailing Address - Country:US
Mailing Address - Phone:954-651-3565
Mailing Address - Fax:754-263-5932
Practice Address - Street 1:1000 N HIATUS RD STE 120
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3094
Practice Address - Country:US
Practice Address - Phone:954-651-3565
Practice Address - Fax:754-263-5932
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2023-09-05
Deactivation Date:2019-08-15
Deactivation Code:
Reactivation Date:2021-03-19
Provider Licenses
StateLicense IDTaxonomies
FLADC-009802-2015101YA0400X
FLCAP.0009802101YA0400X
FLISW15523104100000X
FLSW20973104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)