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Individual

CRYSTAL RENEE-BEAVER O'CONNELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMSW

Contact information

Practice address
50430 SCHOOL HOUSE RD, 100, CANTON, MI 48187-5910
(734) 495-1722
(734) 495-1722
Mailing address
50430 SCHOOL HOUSE RD, 100, CANTON, MI 48187-5910
(734) 495-1722
(734) 495-1722

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801094281
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
213119549
MI
Enumeration date
03/21/2013
Last updated
10/11/2018
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