Provider Demographics
NPI:1578919007
Name:CRUZ, CAPRI (PHD LPC)
Entity Type:Individual
Prefix:DR
First Name:CAPRI
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2886 SANDY PLAINS RD UNIT 669702
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-0208
Mailing Address - Country:US
Mailing Address - Phone:706-829-5448
Mailing Address - Fax:
Practice Address - Street 1:2886 SANDY PLAINS RD UNIT 669702
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-0208
Practice Address - Country:US
Practice Address - Phone:706-829-5448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health