Provider Demographics
NPI:1346614559
Name:CRAIG, LARRY DWAYNE (RAS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DWAYNE
Last Name:CRAIG
Suffix:
Gender:M
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 FLORIN PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3900
Mailing Address - Country:US
Mailing Address - Phone:916-875-1171
Mailing Address - Fax:
Practice Address - Street 1:3201 FLORIN PERKINS RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3900
Practice Address - Country:US
Practice Address - Phone:916-875-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor