Provider Demographics
NPI:1609692078
Name:GAY, CRYSTAL (MS, CAS, NCSP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:GAY
Suffix:
Gender:F
Credentials:MS, CAS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 GARDEN WALK
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4902
Mailing Address - Country:US
Mailing Address - Phone:410-868-1998
Mailing Address - Fax:
Practice Address - Street 1:301 S BEECHFIELD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4034
Practice Address - Country:US
Practice Address - Phone:410-396-0525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30-7518103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool