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General NPI Number Information
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NPI Number | 1730799925
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Entity Type | Organization
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Legal Business Name | CRYSTAL DURRETT, LICENSED CLINICAL SOCIAL WORKER, PC
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 427 F ST STE 234
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City | EUREKA
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State | CA
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Zip | 95501-1037
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Country | US
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Telephone | 707-954-7060
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Fax |
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Provider Business Mailing Address
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Address Line | 427 F ST STE 234
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City | EUREKA
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State | CA
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Zip | 95501-1037
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Country | US
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Telephone | 707-954-7060
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRYSTAL DAWN DURRETT
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Credential | LCSW
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Telephone | 707-954-7060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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