Healthcare Provider Details

I. General information

NPI: 1689088908
Provider Name (Legal Business Name): CRYSTAL ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHAMBERS HILL DR STE 200
CHAMBERSBURG PA
17201-7301
US

IV. Provider business mailing address

111 CHAMBERS HILL DR STE 200
CHAMBERSBURG PA
17201-7304
US

V. Phone/Fax

Practice location:
  • Phone: 717-709-7930
  • Fax: 717-709-7931
Mailing address:
  • Phone: 717-709-7922
  • Fax: 717-263-2055

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: