Healthcare Provider Details

I. General information

NPI: 1689974826
Provider Name (Legal Business Name): CRAIG JAMES LANDRY ADDICTION SPECIALIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE # WARD93
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

2225 23RD ST UNIT 303
SAN FRANCISCO CA
94107-3267
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-8412
  • Fax:
Mailing address:
  • Phone: 415-647-6645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-4542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: