Provider Demographics
NPI:1750947156
Name:CRAIG, JUSTIN BRADLEY (LMSW)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:BRADLEY
Last Name:CRAIG
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 GREENWAY CENTER DR STE 207
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3525
Mailing Address - Country:US
Mailing Address - Phone:240-473-2159
Mailing Address - Fax:
Practice Address - Street 1:7525 GREENWAY CENTER DR STE 207
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3525
Practice Address - Country:US
Practice Address - Phone:240-473-2159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20143104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker