| Doctor Name: | MR. CARSON ETCITTY CRAIG |
| NPI Number: | 1477762318 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LISAC, LSAA |
| License Number: | 11763 |
| Business Practice Address: | Southwest Highland Drive Crownpoint, NM - 873131144 |
| Business Phone Number: | 5057862128 |
| Business Fax Number: | 5057862020 |
| Mailing Address: | P. O. Box 416, CROWNPOINT |
| State: | NM |
| Postal Code: | 873130416 |
| Phone Number: | 5057862257 |
| Fax Number: | 5057862020 |
| NPI Enumeration Date: | 05/21/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 11763 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |