Provider Demographics
NPI:1871704080
Name:CRUZ, MARIA L (MS LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:L
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-3668
Mailing Address - Country:US
Mailing Address - Phone:608-444-2716
Mailing Address - Fax:
Practice Address - Street 1:3332 BRIDGES ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3280
Practice Address - Country:US
Practice Address - Phone:888-557-1675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI106H00000X
NC1637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1871704080Medicaid
NC1871704080Medicaid