Provider Demographics
NPI:1760200513
Name:CRAIG, MICHELE RENEE (LAC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:RENEE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 E ROOSEVELT ST APT 6
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-3471
Mailing Address - Country:US
Mailing Address - Phone:602-348-9909
Mailing Address - Fax:
Practice Address - Street 1:11318 N 145TH LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-4353
Practice Address - Country:US
Practice Address - Phone:480-449-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-23106101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health