Provider Demographics
NPI:1689677114
Name:STULL, CRAIG (MA)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:STULL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 MARINE AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-2816
Mailing Address - Country:US
Mailing Address - Phone:206-329-1660
Mailing Address - Fax:
Practice Address - Street 1:1127 10TH AVE E
Practice Address - Street 2:STE 7
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-4377
Practice Address - Country:US
Practice Address - Phone:206-329-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003470101YM0800X
WACP00003175101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP00003175OtherCHEMICAL DEPENDENCY PROF
WALH00003470OtherLICENSED MH COUNSELOR