Healthcare Provider Details

I. General information

NPI: 1821540279
Provider Name (Legal Business Name): CRYSTAL PRICE MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 QUARRIER ST STE 310
CHARLESTON WV
25301-2338
US

IV. Provider business mailing address

1021 QUARRIER ST STE 310
CHARLESTON WV
25301-2338
US

V. Phone/Fax

Practice location:
  • Phone: 304-419-8890
  • Fax:
Mailing address:
  • Phone: 304-419-8890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP010863
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00945496
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: