MEDICARE: CRYSTAL MENSAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor
4	101YS0200X	School Counselor
5	103K00000X	Behavior Analyst
6	1041C0700X	Clinical Social Worker
7	1041S0200X	School Social Worker

General Provider Information

NPI Number	:	1184086605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MENSAH

Provider Business Mailing Address
First Line	:	14472 GENERAL WASHINGTON DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-3249
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1335 GREENMOSS DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-4112
Country	:	US
Telephone Number	:	804-714-9779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	03/23/2016

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Directions to “ CRYSTAL MENSAH ” Practice Location

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