Provider Demographics
NPI:1689974826
Name:LANDRY, CRAIG JAMES (ADDICTION SPECIALIST)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:JAMES
Last Name:LANDRY
Suffix:
Gender:M
Credentials:ADDICTION SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 23RD ST UNIT 303
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-3267
Mailing Address - Country:US
Mailing Address - Phone:415-647-6645
Mailing Address - Fax:
Practice Address - Street 1:1001 POTRERO AVE # WARD93
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-8412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-4542101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)