| NPI | 1316377658 |
|---|---|
| Former Name | CRYSTAL DEANNA GAVIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL ISW6558) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW14735) |
| Enumeration Date | 2013-11-23 |
| Last Update Date | 2022-05-31 |