Healthcare Provider Details

I. General information

NPI: 1982924536
Provider Name (Legal Business Name): ALICIA CRAIG M.B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2010
Last Update Date: 06/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3729 W DUNBAR DR
PHOENIX AZ
85041-6150
US

IV. Provider business mailing address

5501 N 19TH AVE SUITE 310
PHOENIX AZ
85015-2450
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-9366
  • Fax:
Mailing address:
  • Phone: 602-433-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11618
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: