Provider Demographics
NPI:1144534561
Name:CRAIG, NICOLE L (MA, LPC, CADCI)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MA, LPC, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 SE JEFFERSON ST STE 205C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7691
Mailing Address - Country:US
Mailing Address - Phone:503-444-9948
Mailing Address - Fax:
Practice Address - Street 1:2027 SE JEFFERSON ST STE 205C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222-7691
Practice Address - Country:US
Practice Address - Phone:503-444-9948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)