Provider Demographics
NPI:1871252783
Name:CRAIG, LARRY DEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DEAN
Last Name:CRAIG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92652-0969
Mailing Address - Country:US
Mailing Address - Phone:949-494-1986
Mailing Address - Fax:
Practice Address - Street 1:120 NEWPORT CENTER DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6916
Practice Address - Country:US
Practice Address - Phone:949-715-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1050091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical