Individual
BRYAN SETH CRUISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
140 LARKSPUR LN, GALAX, VA 24333-2752
(276) 601-8458
Mailing address
140 LARKSPUR LN, GALAX, VA 24333-2752
(276) 601-8458
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0709025292
VA
Other
Enumeration date
06/26/2024
Last updated
06/26/2024
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