Provider Demographics
NPI:1972289122
Name:SHAW, CRYSTAL (LCMHC, CRC)
Entity type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:LCMHC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7620 RIVERS AVE STE 370
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-5008
Mailing Address - Country:US
Mailing Address - Phone:843-277-8567
Mailing Address - Fax:
Practice Address - Street 1:107 PINECREST TRL
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-7429
Practice Address - Country:US
Practice Address - Phone:843-277-8567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10482101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional