Provider Demographics
NPI:1801149539
Name:CRITES, STEVEN RUSSELL (LGPC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:RUSSELL
Last Name:CRITES
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 N BENTZ ST
Mailing Address - Street 2:CMBT
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4913
Mailing Address - Country:US
Mailing Address - Phone:301-631-2936
Mailing Address - Fax:301-631-2937
Practice Address - Street 1:5 N BENTZ ST
Practice Address - Street 2:CMBT
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4913
Practice Address - Country:US
Practice Address - Phone:301-631-2936
Practice Address - Fax:301-631-2937
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP3855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health