Provider Information for 1790044915
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CRYSTAL ERVIN LPC
Sex: Female
NPI: 1790044915
Last Updated: 2018-08-27
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1790044915 | ||||||||||||
| Enumeration Date | 2012-05-08 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 109 ASTERIA ST GREENVILLE, SC 29607-6326 United States Phone: 864-315-8189 | Fax:864-412-8516 | ||||||||||||
| Primary Practice Address | 1 CHICK SPRINGS RD STE 210A GREENVILLE, SC 29609 United States Phone: 864-569-7344 | Fax:864-412-8516 | ||||||||||||
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