Healthcare Provider Details

I. General information

NPI: 1003385725
Provider Name (Legal Business Name): KRYSTAL MARIE LEE DANCY MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTAL MARIE MCCULLEN MSW, LCSW

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAG HOHENFELS ARMY HEALTH CLINIC
HOHENFELS GERMANY
09173
DE

IV. Provider business mailing address

CMR 414 BOX 1463
APO AE
09173-1015
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-3354
  • Fax:
Mailing address:
  • Phone: 919-394-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC011536
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: