Provider Demographics
NPI:1336645498
Name:CRAIG, NICOLE MARGARET (LSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARGARET
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17317 MADISON AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3568
Mailing Address - Country:US
Mailing Address - Phone:810-278-4042
Mailing Address - Fax:
Practice Address - Street 1:17317 MADISON AVE APT 12
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3568
Practice Address - Country:US
Practice Address - Phone:810-278-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802022104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker