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General NPI Number Information
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NPI Number | 1548799166
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Entity Type | Individual
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Provider Name | CRYSTAL ELAINE MULLEN-JOHNSON LICSW, PIP,
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Gender | Female
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 06/07/2017
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Provider Practice Location Address
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Address Line | 2024 3RD AVE N STE 312
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City | BIRMINGHAM
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State | AL
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Zip | 35203-3302
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Country | US
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Telephone | 205-721-9893
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Fax |
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Provider Business Mailing Address
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Address Line | 601 HICKORY ST
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City | BIRMINGHAM
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State | AL
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Zip | 35206-1616
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Country | US
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Telephone | 205-913-6078
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1332-3980C
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License Number State | AL
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