1164845624 NPI number — KRYSTAL LATRICE ARMSTRONG MA LPC CADC

Table of content: KRYSTAL LATRICE ARMSTRONG MA LPC CADC (NPI 1164845624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164845624 NPI number — KRYSTAL LATRICE ARMSTRONG MA LPC CADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARMSTRONG
Provider First Name:
KRYSTAL
Provider Middle Name:
LATRICE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA LPC CADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164845624
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 CASS AVE
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
MOUNT CLEMENS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48043-2252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-339-5744
Provider Business Mailing Address Fax Number:
586-314-6375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 CASS AVE
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
MOUNT CLEMENS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48043-2252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-339-5744
Provider Business Practice Location Address Fax Number:
586-314-6375
Provider Enumeration Date:
02/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  6401011876 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 2-01230 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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