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General NPI Number Information
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NPI Number | 1962952226
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Entity Type | Individual
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Provider Name | CRYSTAL PRESTIA LCSW, CAP
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Gender | Female
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 1000 N HIATUS RD STE 120
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3094
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Country | US
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Telephone | 954-651-3565
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Fax | 754-263-5932
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Provider Business Mailing Address
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Address Line | 1000 N HIATUS RD STE 120
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3094
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Country | US
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Telephone | 954-651-3565
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Fax | 754-263-5932
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ADC-009802-2015
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAP.0009802
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ISW15523
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW20973
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License Number State | FL
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