Provider Demographics
NPI:1033636329
Name:WOOD, CRYSTAL
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 TANGLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-1022
Mailing Address - Country:US
Mailing Address - Phone:478-279-7214
Mailing Address - Fax:833-478-1298
Practice Address - Street 1:1717 RICE AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3524
Practice Address - Country:US
Practice Address - Phone:800-832-9419
Practice Address - Fax:855-859-1671
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-16-26861103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst