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MRS. CRYSTAL LEIGH ROBERTS NCC,MA

Addiction Substance Use Disorder

Gulfport, Mississippi

Provider NPI: 1447270509

Provider Information:
MRS. CRYSTAL LEIGH ROBERTS NCC,MA
Gender: F
Not Sole Proprietor

Practice Location:
1600 BROAD AVE  GULFPORT, MS 39501 US
Tel: 228-863-1132  Fax: 228-865-1700

Business Mailing Address:
1600 BROAD AVE  GULFPORT, MS 39501 US
Tel: 228-863-1132  Fax: 228-865-1700

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
X101YM0800XBehavioral Health & Social Service Providers
Counselor

Other Provider Identifiers:

IssuerNumberStateType
00018213MS05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







ADDICTION JOBS MS - Page 1



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