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General NPI Number Information
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NPI Number | 1538717418
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Entity Type | Individual
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Provider Name | CRYSTAL HARRIS LMSW, CADC II
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Gender | Female
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 175 GWINNETT DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8444
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Country | US
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Telephone | 678-209-2394
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Fax |
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Provider Business Mailing Address
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Address Line | 505 NAVARRE DR
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-5112
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Country | US
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Telephone | 912-441-4270
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW008221
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License Number State | GA
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