Provider Demographics
NPI:1952555856
Name:FORD, CRAIG RODNEY (DMIN, MA)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:RODNEY
Last Name:FORD
Suffix:
Gender:M
Credentials:DMIN, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 S TRUMBULL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7692
Mailing Address - Country:US
Mailing Address - Phone:989-893-2121
Mailing Address - Fax:
Practice Address - Street 1:690 S TRUMBULL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7692
Practice Address - Country:US
Practice Address - Phone:989-893-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008289101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor