Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP2500X | Professional Counselor | ||
N | 101YS0200X | School Counselor | ||
N | 103K00000X | Behavior Analyst | ||
Y | 1041C0700X | Clinical Social Worker | ||
N | 1041S0200X | School Social Worker |
NPI | 1184086605 |
---|---|
Provider Name | Crystal Mensah |
First Address | Woodbridge, VA 22193-3249 |
Second Address | Richmond, VA 23225-4112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2016 |
Last Update Date | 23/03/2016 |