Healthcare Provider Details

I. General information

NPI: 1033975651
Provider Name (Legal Business Name): KRYSTAL FRAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GRISTMILL DR
FOREST VA
24551-2627
US

IV. Provider business mailing address

216 E CADBURY DR
LYNCHBURG VA
24501-2308
US

V. Phone/Fax

Practice location:
  • Phone: 434-202-4080
  • Fax:
Mailing address:
  • Phone: 814-330-6058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701014690
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: