Healthcare Provider Details

I. General information

NPI: 1093530032
Provider Name (Legal Business Name): CRYSTAL LYNN YODER-SHEEHAN LMSW-CC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 COASTAL VILLAGE DR
BRUNSWICK GA
31520-1974
US

IV. Provider business mailing address

101 CRESTVIEW DR
WOODBINE GA
31569-3550
US

V. Phone/Fax

Practice location:
  • Phone: 912-554-8500
  • Fax:
Mailing address:
  • Phone: 912-674-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW011833
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26556
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: