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General NPI Number Information
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NPI Number | 1891495818
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Entity Type | Individual
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Provider Name | CRYSTAL DAWN O'GORMAN LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 03/01/2026
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Provider Practice Location Address
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Address Line | 6401 CARMEL RD STE 105
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City | CHARLOTTE
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State | NC
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Zip | 28226-8364
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Country | US
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Telephone | 704-275-3432
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Fax |
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Provider Business Mailing Address
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Address Line | 6401 CARMEL RD STE 105
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City | CHARLOTTE
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State | NC
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Zip | 28226-8364
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Country | US
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Telephone | 704-275-3432
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 01661
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 8214
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License Number State | SC
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