Healthcare Provider Details

I. General information

NPI: 1982511069
Provider Name (Legal Business Name): MRS. CRYSTAL LYNN SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4490 ROBERTA RD
CONCORD NC
28027-8913
US

IV. Provider business mailing address

4490 ROBERTA RD
CONCORD NC
28027-8913
US

V. Phone/Fax

Practice location:
  • Phone: 517-920-2377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023611
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: