Healthcare Provider Details

I. General information

NPI: 1750716304
Provider Name (Legal Business Name): CRYSTAL SCHULZE M.S., LPC, LPCS, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103B HARTH PL
SUMMERVILLE SC
29485-8107
US

IV. Provider business mailing address

103B HARTH PL
SUMMERVILLE SC
29485-8107
US

V. Phone/Fax

Practice location:
  • Phone: 843-879-3520
  • Fax: 843-879-2174
Mailing address:
  • Phone: 843-879-3520
  • Fax: 843-879-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6184
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6184
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: