=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962214841
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRYSTAL DAWN DOIRON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2025
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11512 LAKE MEAD AVE UNIT 405
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-9687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-577-6257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1383 ODEN CT
-----------------------------------------------------
City | MIDDLEBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32068-7860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-315-4567
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | SW24134
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------