Healthcare Provider Details

I. General information

NPI: 1184109563
Provider Name (Legal Business Name): MARIOLA CRAVER MS, PPS, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 RANCHEROS DR
SAN MARCOS CA
92069-2900
US

IV. Provider business mailing address

43538 SAVONA ST
TEMECULA CA
92592-9248
US

V. Phone/Fax

Practice location:
  • Phone: 760-744-3672
  • Fax:
Mailing address:
  • Phone: 508-479-8357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPCC5281
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC10713
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC10713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: