Provider Demographics
NPI:1598322653
Name:CRAIG, BRUCE ANTHONY JR
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ANTHONY
Last Name:CRAIG
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 PRINCESS ANNE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5800
Mailing Address - Country:US
Mailing Address - Phone:760-409-1929
Mailing Address - Fax:
Practice Address - Street 1:904 PRINCESS ANNE ST STE 301
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5800
Practice Address - Country:US
Practice Address - Phone:760-409-1929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional