Healthcare Provider Details

I. General information

NPI: 1710477617
Provider Name (Legal Business Name): CRYSTAL ANN HANK LCP, PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 AMHERST ST STE F
WINCHESTER VA
22601-2841
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 200
WINCHESTER VA
22601-2889
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-0010
  • Fax: 540-536-0061
Mailing address:
  • Phone: 540-454-0307
  • Fax: 540-536-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005957
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: