Provider Demographics
NPI:1437735156
Name:CRISSMAN, BRIAN (CACII)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CRISSMAN
Suffix:
Gender:M
Credentials:CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11979 HOME GUARD DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1039
Mailing Address - Country:US
Mailing Address - Phone:571-330-8033
Mailing Address - Fax:202-822-9130
Practice Address - Street 1:2112 F ST NW STE 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2722
Practice Address - Country:US
Practice Address - Phone:202-296-4455
Practice Address - Fax:202-822-9130
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACII1022101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty