Provider Demographics
NPI:1861067779
Name:BRUCE A. CRAIG, PC
Entity type:Organization
Organization Name:BRUCE A. CRAIG, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA
Authorized Official - Phone:760-409-1929
Mailing Address - Street 1:1918 WHITE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1482
Mailing Address - Country:US
Mailing Address - Phone:760-409-1929
Mailing Address - Fax:
Practice Address - Street 1:904 PRINCESS ANNE ST STE 301
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5800
Practice Address - Country:US
Practice Address - Phone:760-409-1929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty