MEDICARE: MS. DENISE ARNIESHA CRAIG M.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	14635	FL
2	171M00000X	Case Manager/Care Coordinator
3	101YM0800X	Mental Health Counselor	MH20239	FL

General Provider Information

NPI Number	:	1427309913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE ARNIESHA CRAIG M.S

Provider Business Mailing Address
First Line	:	1894 SE GRAND DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-7794
Country	:	US
Telephone Number	:	772-600-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1894 SE GRAND DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-7794
Country	:	US
Telephone Number	:	772-600-6001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2012
Last Update Date	:	01/27/2022

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