Provider Demographics
NPI:1043097389
Name:CRAIG, POLLY (LPCC)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 KEARNS WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8270
Mailing Address - Country:US
Mailing Address - Phone:757-581-0810
Mailing Address - Fax:
Practice Address - Street 1:1043 CENTER DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3838
Practice Address - Country:US
Practice Address - Phone:859-338-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY285219101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor