Individual
CRYSTAL L DILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1600 7TH AVE S, ACC 500, BIRMINGHAM, AL 35233-1711
(205) 939-9193
(205) 939-9949
Mailing address
PO BOX 11407 DRAWER 1492, BIRMINGHAM, AL 35246-1492
(205) 939-9193
(205) 939-9949
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1545
AL
103TC0700X
Clinical Psychologist
1545
AL
103TH0100X
Health Service Psychologist
2829
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109018
—
AL
05
—
109021
—
AL
01
—
1679723241
TRICARE SOUTH
AL
01
—
515-97316
BCBS
AL
01
—
515-97317
BCBS
AL
01
—
515-98119
FEDERAL BC
AL
01
—
515-98120
FEDERAL BC
AL
Enumeration date
09/19/2008
Last updated
03/26/2010
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