Individual
CRYSTAL ARTIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3640 KENNY LN, PORTSMOUTH, VA 23703-2645
(757) 765-0755
Mailing address
3640 KENNY LN, PORTSMOUTH, VA 23703-2645
(703) 400-6646
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/04/2022
Last updated
04/22/2026
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