Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 6401015347 | MI |
Y | 101YM0800X | Mental Health Counselor | 6401015347 | MI |
N | 103G00000X | Clinical Psychologist | 6301016619 | MI |
N | 103TC0700X | Clinical Psychologist | 6301016619 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301016619 | MI |
N | 103G00000X | Clinical Psychologist | 6301016619 | MI |
N | 103TC0700X | Clinical Psychologist | 6301016619 | MI |
N | 103TP2701X | Group Psychotherapist | 6301016619 | MI |
NPI | 1114389194 |
---|---|
Provider Name | Jeannie Craig |
First Address | Clarkston, MI 48346-1825 |
Second Address | Clarkston, MI 48346-1825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 28/03/2016 |