Provider Demographics
NPI:1962032052
Name:CRAIG, SALLY JOY (LPC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:JOY
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W 4J RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-9109
Mailing Address - Country:US
Mailing Address - Phone:307-682-5433
Mailing Address - Fax:307-682-7004
Practice Address - Street 1:1800 W 4J RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-9109
Practice Address - Country:US
Practice Address - Phone:307-682-5433
Practice Address - Fax:307-682-7004
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY588101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor