Provider Demographics
NPI:1427309913
Name:CRAIG, DENISE ARNIESHA (MS)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:ARNIESHA
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1894 SE GRAND DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7794
Mailing Address - Country:US
Mailing Address - Phone:772-600-6001
Mailing Address - Fax:
Practice Address - Street 1:1894 SE GRAND DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7794
Practice Address - Country:US
Practice Address - Phone:772-600-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14635101YM0800X
171M00000X
FLMH20239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator