Provider Demographics
NPI:1154472637
Name:SMITH, CRAIG A (MS, LLP)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49626-0304
Mailing Address - Country:US
Mailing Address - Phone:231-723-7532
Mailing Address - Fax:
Practice Address - Street 1:50 FILER ST
Practice Address - Street 2:SUITE 320
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2726
Practice Address - Country:US
Practice Address - Phone:231-398-0948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007730103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical