Healthcare Provider Details

I. General information

NPI: 1639229214
Provider Name (Legal Business Name): CRAIG SPENCER WASCOVICH D. MIN. ,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 VINE CT
NASHVILLE TN
37205-2052
US

IV. Provider business mailing address

3337 SUNNY SLOPE DR
CLARKSVILLE TN
37043-7865
US

V. Phone/Fax

Practice location:
  • Phone: 615-383-0792
  • Fax:
Mailing address:
  • Phone: 931-368-1628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberCPT0000000043
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: