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General NPI Number Information
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NPI Number | 1598572406
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Entity Type | Organization
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Legal Business Name | CRYSTAL MENTAL HEALTH AND WELLNESS
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 3718 AUTUMN GOLD CT
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City | CHARLOTTE
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State | NC
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Zip | 28278-7287
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Country | US
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Telephone | 704-584-7741
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Fax |
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Provider Business Mailing Address
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Address Line | 3718 AUTUMN GOLD CT
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City | CHARLOTTE
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State | NC
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Zip | 28278-7287
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Country | US
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Telephone | 704-584-7741
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAKEBA MATTHEWS
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Credential |
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Telephone | 704-584-7741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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