Provider Demographics
NPI:1164914727
Name:CRAIG, EILEEN M (MA COUNSELING)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MA COUNSELING
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:M
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LLPC
Mailing Address - Street 1:3421 PINE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-8694
Mailing Address - Country:US
Mailing Address - Phone:517-861-6862
Mailing Address - Fax:
Practice Address - Street 1:3421 PINE CREEK DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-8694
Practice Address - Country:US
Practice Address - Phone:517-861-6862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016665101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional