Basic Information
| Provider Information | |||||||||
| NPI: | 1891847489 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 900 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242830900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767620770 | ||||||||
| FaxNumber: | 2767620678 | ||||||||
| Practice Location | |||||||||
| Address1: | HWY 63 NORTH | ||||||||
| Address2: | CLINIC STREET | ||||||||
| City: | ST. PAUL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767620770 | ||||||||
| FaxNumber: | 2767620678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904004835 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.