Healthcare Provider Details

I. General information

NPI: 1720754328
Provider Name (Legal Business Name): IMANI ALEXANDRA CRAIG LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 BRIGADIER WAY APT 411
ABERDEEN MD
21001-1379
US

IV. Provider business mailing address

880 BRIGADIER WAY APT 411
ABERDEEN MD
21001-1379
US

V. Phone/Fax

Practice location:
  • Phone: 436-254-1600
  • Fax:
Mailing address:
  • Phone: 436-254-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27696
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904018554
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: