Healthcare Provider Details

I. General information

NPI: 1306503693
Provider Name (Legal Business Name): CRYSTAL BAPTISTE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2021
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 W 7TH ST STE 500
FREDERICK MD
21701-8512
US

IV. Provider business mailing address

4206 INDIAN HEAD HWY
INDIAN HEAD MD
20640-1736
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-1022
  • Fax: 301-560-5558
Mailing address:
  • Phone: 704-701-9727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC16462
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: