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NPI Code Detail

MEDICARE: CRYSTOL WITT

MEDICARE: CRYSTOL WITT
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor6451016047MI

General Provider Information

NPI Number : 1831567056
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTOL WITT
Provider Business Mailing Address
First Line : 11105 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48214-3317
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11105 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48214-3317
Country : US
Telephone Number : 734-785-7700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2015
Last Update Date : 08/20/2025

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Directions to “ CRYSTOL WITT ” Practice Location

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