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General NPI Number Information
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NPI Number | 1659935856
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Entity Type | Individual
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Provider Name | RIA CRISSINGER LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 1816 E 7TH ST
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City | CHARLOTTE
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State | NC
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Zip | 28204-2416
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Country | US
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Telephone | 704-313-9071
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Fax |
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Provider Business Mailing Address
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Address Line | 1536 SPRING BLOSSOM TRL
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City | FORT MILL
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State | SC
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Zip | 29708-0120
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Country | US
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Telephone | 803-412-1312
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A14714
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License Number State | NC
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