Provider Demographics
NPI:1912296039
Name:WITCHER, CRAIG
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:WITCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W O ST
Mailing Address - Street 2:HEALTH AND WELLNESS CENTER, DEAN HALL 126
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-8810
Mailing Address - Country:US
Mailing Address - Phone:479-968-0329
Mailing Address - Fax:
Practice Address - Street 1:402 W O ST
Practice Address - Street 2:HEALTH AND WELLNESS CENTER, DEAN HALL 126
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-8810
Practice Address - Country:US
Practice Address - Phone:479-968-0329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1208068101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor