Crystal Lorraine Fowlkes, BT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

6325 N Center Dr Ste 121
Norfolk, VA 23502-0012

Phone

(757) 901-0646

NPI assigned

Dec 21, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Theology

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Your Life ABA VA, LLC

  • Behavior Analyst
  • New York, NY
  • NPI 1023772001
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1386356236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5812 DUNKIRK ST",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237033128",
            "telephone_number": "757-578-6003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6325 N CENTER DR STE 121",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235020012",
            "telephone_number": "757-901-0646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLKES",
        "first_name": "CRYSTAL",
        "middle_name": "LORRAINE",
        "credential": "BT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-21",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Jerome Foster, MD
• Tanema A Foster
• Victoria Ann Foster, LPC
• Christina Lynn Fotopoulos
• Angela Michele Fountain, NP-C
• David Samuel Fox, PA-C
• Kristyn Dolores Fox
• Justin Adrian Foxworth, IDC
• Althea Francis, LICENSE MASSAGE THER
• Vernon Francis, M.D.

• Behavior Technician in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Behavior Technician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.