Provider Demographics
NPI:1952778524
Name:CRAIG, NIKISSIA (LCSW)
Entity Type:Individual
Prefix:
First Name:NIKISSIA
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W BUTE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1348
Mailing Address - Country:US
Mailing Address - Phone:757-622-1060
Mailing Address - Fax:757-622-1601
Practice Address - Street 1:309 W BUTE ST STE 200
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1348
Practice Address - Country:US
Practice Address - Phone:757-622-1060
Practice Address - Fax:757-622-1601
Is Sole Proprietor?:No
Enumeration Date:2015-08-30
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040091441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical