Provider Demographics
NPI:1700289659
Name:PIERCE, CRAIG ANTHONY JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ANTHONY
Last Name:PIERCE
Suffix:JR
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:PO BOX 2054
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-2054
Mailing Address - Country:US
Mailing Address - Phone:985-778-3652
Mailing Address - Fax:985-778-2010
Practice Address - Street 1:1510 W CAUSEWAY APPROACH
Practice Address - Street 2:STE E
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3022
Practice Address - Country:US
Practice Address - Phone:985-778-3652
Practice Address - Fax:985-778-2010
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM8127104100000X
LA113191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker