| Doctor Name: | MRS. CRYSTAL DENEE' BUSH |
| NPI Number: | 1265532527 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LCSW LCAS CSI |
| License Number: | 1615 |
| Business Practice Address: | 101 Industrial Dr Louisburg, NC - 275492307 |
| Business Phone Number: | 8772584795 |
| Business Fax Number: | 8665839593 |
| Mailing Address: | 105 Ambergate Dr, YOUNGSVILLE |
| State: | NC |
| Postal Code: | 275967448 |
| Phone Number: | 9195398520 |
| Fax Number: | 8665839593 |
| NPI Enumeration Date: | 09/25/2006 |
| NPI Last Update Date: | 05/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1615 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |