Provider Demographics
NPI:1730730714
Name:BATTLE, CRYSTAL DIANE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DIANE
Last Name:BATTLE
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 1:1649 TRINIDAD AVE NE APT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2746
Mailing Address - Country:US
Mailing Address - Phone:443-224-6786
Mailing Address - Fax:
Practice Address - Street 1:1010 VERMONT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4902
Practice Address - Country:US
Practice Address - Phone:202-322-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-22
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health