Healthcare Provider Details

I. General information

NPI: 1730970054
Provider Name (Legal Business Name): TRUDY M CRAIG LIAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W 29TH ST
TUCSON AZ
85713-3394
US

IV. Provider business mailing address

645 W ASH RIDGE DR
GREEN VALLEY AZ
85614-5493
US

V. Phone/Fax

Practice location:
  • Phone: 520-884-9920
  • Fax:
Mailing address:
  • Phone: 520-440-5129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number155377
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: