Provider Demographics
NPI:1922131127
Name:PIERCE, CRAIG L (PHD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:L
Last Name:PIERCE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 TEXAS ST., NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4058
Mailing Address - Country:US
Mailing Address - Phone:505-830-1871
Mailing Address - Fax:505-369-1121
Practice Address - Street 1:2612 TEXAS ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4684
Practice Address - Country:US
Practice Address - Phone:505-830-1871
Practice Address - Fax:505-369-1121
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1244101YM0800X
NM1243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health