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General NPI Number Information
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NPI Number | 1962207308
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Entity Type | Individual
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Provider Name | CRYSTAL ADCOCK WRIGHT LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 1201 CONCORD AVE
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City | MONROE
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State | NC
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Zip | 28110-2907
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Country | US
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Telephone | 704-465-4974
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Fax | 704-465-4974
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Provider Business Mailing Address
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Address Line | 6007 OLD GOLDMINE RD
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City | MARSHVILLE
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State | NC
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Zip | 28103-9084
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Country | US
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Telephone | 704-465-4974
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A21101
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License Number State | NC
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