Provider Demographics
NPI:1245486174
Name:RICH, CRAIG JAY (LCSW)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:JAY
Last Name:RICH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 POYNER DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36870-2835
Mailing Address - Country:US
Mailing Address - Phone:606-207-0965
Mailing Address - Fax:
Practice Address - Street 1:2914 POYNER DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36870-2835
Practice Address - Country:US
Practice Address - Phone:606-207-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04335300101YM0800X
GACSW0048671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health