Provider Demographics
NPI:1487972642
Name:CRAIG, MARY M
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:M
Last Name:CRAIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-6703
Mailing Address - Country:US
Mailing Address - Phone:707-642-4554
Mailing Address - Fax:707-642-2755
Practice Address - Street 1:509 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1653
Practice Address - Country:US
Practice Address - Phone:925-777-9540
Practice Address - Fax:925-757-9024
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist