Provider Demographics
NPI: | 1215638598 |
---|---|
Name: | V. CRAIG FAMILY THERAPY INC. |
Entity type: | Organization |
Organization Name: | V. CRAIG FAMILY THERAPY INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | VALYNE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CRAIG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMFT |
Authorized Official - Phone: | 916-318-9204 |
Mailing Address - Street 1: | 18564 US HIGHWAY 18 STE 205-A1 |
Mailing Address - Street 2: | |
Mailing Address - City: | APPLE VALLEY |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92307-2312 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 916-318-9204 |
Mailing Address - Fax: | 760-478-6279 |
Practice Address - Street 1: | 18564 US HIGHWAY 18 STE 205-A1 |
Practice Address - Street 2: | |
Practice Address - City: | APPLE VALLEY |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92307-2312 |
Practice Address - Country: | US |
Practice Address - Phone: | 916-318-9204 |
Practice Address - Fax: | 760-478-6279 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-03-14 |
Last Update Date: | 2023-03-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty |