Healthcare Provider Details

I. General information

NPI: 1487972642
Provider Name (Legal Business Name): MS. MARY M. CRAIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W 10TH ST
ANTIOCH CA
94509-1653
US

IV. Provider business mailing address

645 LOCKWOOD DR
VALLEJO CA
94591-6703
US

V. Phone/Fax

Practice location:
  • Phone: 925-777-9540
  • Fax: 925-757-9024
Mailing address:
  • Phone: 707-642-4554
  • Fax: 707-642-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: