Provider Demographics
NPI:1114389194
Name:CRAIG, JEANNIE (TLLP, LLPC)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:TLLP, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3383 S LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-8968
Mailing Address - Country:US
Mailing Address - Phone:810-406-1660
Mailing Address - Fax:248-970-0210
Practice Address - Street 1:3383 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-8968
Practice Address - Country:US
Practice Address - Phone:810-406-1660
Practice Address - Fax:248-970-0210
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015347101YA0400X, 101YM0800X
MI6301016619103G00000X, 103TB0200X, 103TC0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy