Provider Demographics
NPI:1639229214
Name:WASCOVICH, CRAIG SPENCER (D MIN ,)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:SPENCER
Last Name:WASCOVICH
Suffix:
Gender:M
Credentials:D MIN ,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3337 SUNNY SLOPE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-7865
Mailing Address - Country:US
Mailing Address - Phone:931-368-1628
Mailing Address - Fax:
Practice Address - Street 1:100 VINE CT
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2052
Practice Address - Country:US
Practice Address - Phone:615-383-0792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCPT0000000043101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral