Provider Demographics
NPI:1992876106
Name:CRAIGEN, LAURIE M (PHD, LPC, EDS)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:M
Last Name:CRAIGEN
Suffix:
Gender:F
Credentials:PHD, LPC, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6072 GODWIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23432-1012
Mailing Address - Country:US
Mailing Address - Phone:757-255-2555
Mailing Address - Fax:757-255-7009
Practice Address - Street 1:6072 GODWIN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23432-1012
Practice Address - Country:US
Practice Address - Phone:757-255-2555
Practice Address - Fax:757-255-7009
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003999101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health