Provider Demographics
NPI:1184109563
Name:CRAVER, MARIOLA (MS, PPS, LPCC)
Entity type:Individual
Prefix:
First Name:MARIOLA
Middle Name:
Last Name:CRAVER
Suffix:
Gender:F
Credentials:MS, PPS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43538 SAVONA ST
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-9248
Mailing Address - Country:US
Mailing Address - Phone:508-479-8357
Mailing Address - Fax:
Practice Address - Street 1:340 RANCHEROS DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2900
Practice Address - Country:US
Practice Address - Phone:760-744-3672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC5281101Y00000X
CALPCC10713101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALPCC10713OtherLPCC