Provider Demographics
NPI:1982212940
Name:CRAIG, DIANE RENE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:RENE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-1589
Mailing Address - Country:US
Mailing Address - Phone:413-233-1494
Mailing Address - Fax:413-746-0368
Practice Address - Street 1:628 CENTER ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1589
Practice Address - Country:US
Practice Address - Phone:413-233-1494
Practice Address - Fax:413-746-0368
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor