Provider Demographics
NPI:1992516074
Name:BARKSDALE, CRYSTAL L (PHD, MPH)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:L
Last Name:BARKSDALE
Suffix:
Gender:F
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 RIVER BEND CT APT D204
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-6004
Mailing Address - Country:US
Mailing Address - Phone:240-498-2722
Mailing Address - Fax:
Practice Address - Street 1:3109 RIVER BEND CT APT D204
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-6004
Practice Address - Country:US
Practice Address - Phone:240-498-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04629103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist