Healthcare Provider Details

I. General information

NPI: 1356715833
Provider Name (Legal Business Name): CRYSTAL MARCUS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL POWELL M.A.

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 WALTER ST SE
WASHINGTON DC
20003-1449
US

IV. Provider business mailing address

PO BOX 15828
CHEVY CHASE MD
20825-5828
US

V. Phone/Fax

Practice location:
  • Phone: 202-596-5951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: