Provider Demographics
NPI:1487395893
Name:SMITH, CRAIG (LMHCA)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 WOODCREST DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3845
Mailing Address - Country:US
Mailing Address - Phone:360-522-5528
Mailing Address - Fax:
Practice Address - Street 1:2112 WOODCREST DR SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-3845
Practice Address - Country:US
Practice Address - Phone:360-522-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC6120513101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health