Healthcare Provider Details

I. General information

NPI: 1538941711
Provider Name (Legal Business Name): STEVEN CRAIG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 MAGNOLIA AVE
LONG BEACH CA
90806-4521
US

IV. Provider business mailing address

4624 GRAYWOOD AVE
LONG BEACH CA
90808-1017
US

V. Phone/Fax

Practice location:
  • Phone: 562-218-1868
  • Fax: 562-591-0346
Mailing address:
  • Phone: 562-414-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16112
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-YOUADE
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: