Provider Demographics
NPI:1659728384
Name:CRAIG, SAMUEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:CRAIG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17274 BENTLER ST APT 50
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-4717
Mailing Address - Country:US
Mailing Address - Phone:248-470-7279
Mailing Address - Fax:313-766-6465
Practice Address - Street 1:2520 ELIZABETH LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3312
Practice Address - Country:US
Practice Address - Phone:248-706-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)