Provider Demographics
NPI:1902559859
Name:WEST, KRYSTAL (LCSW)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4345 PALISADES PLACE DR
Mailing Address - Street 2:
Mailing Address - City:STONECREST
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6146
Mailing Address - Country:US
Mailing Address - Phone:256-527-3164
Mailing Address - Fax:
Practice Address - Street 1:4345 PALISADES PLACE DR
Practice Address - Street 2:
Practice Address - City:STONECREST
Practice Address - State:GA
Practice Address - Zip Code:30038-6146
Practice Address - Country:US
Practice Address - Phone:678-421-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0079011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical