Provider Demographics
NPI:1235587098
Name:CRAIG, GINA LORRAINE (MS ED, BCBA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LORRAINE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MS ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12681 CAPITOLA RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-8920
Mailing Address - Country:US
Mailing Address - Phone:352-502-1487
Mailing Address - Fax:
Practice Address - Street 1:12681 CAPITOLA RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-8920
Practice Address - Country:US
Practice Address - Phone:352-502-1487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst