Provider Demographics
NPI:1548936826
Name:HOLLENBECK, CRYSTAL (EDD, LMHC)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:HOLLENBECK
Suffix:
Gender:F
Credentials:EDD, LMHC
Other - Prefix:DR
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:HOLLENBECK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD, LMHC
Mailing Address - Street 1:8015 INTERNATIONAL DR # 302
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9312
Mailing Address - Country:US
Mailing Address - Phone:407-408-6521
Mailing Address - Fax:
Practice Address - Street 1:7345 W SAND LAKE RD STE 303
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5205
Practice Address - Country:US
Practice Address - Phone:407-408-6521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health