Healthcare Provider Details

I. General information

NPI: 1336276732
Provider Name (Legal Business Name): CRYSTAL MARIE ADAMS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 VICTORIA ST W
COMPTON CA
90220
US

IV. Provider business mailing address

3763 HALLDALE AVE
LOS ANGELES CA
90018-4544
US

V. Phone/Fax

Practice location:
  • Phone: 310-868-5379
  • Fax:
Mailing address:
  • Phone: 323-810-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: