Individual
MR. CRAIG VIKING GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
615 CHIMBORAZO BLVD, RICHMOND, VA 23223-7530
(303) 875-5869
Mailing address
PO BOX 4465, RICHMOND, VA 23220-8465
(303) 875-5869
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0157485415
—
VA
Enumeration date
04/15/2010
Last updated
04/15/2010
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