Healthcare Provider Details

I. General information

NPI: 1588963474
Provider Name (Legal Business Name): KIYOI JOY CRAIG LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5890 KALAMAZOO AVE SE
KENTWOOD MI
49508-6416
US

IV. Provider business mailing address

5890 KALAMAZOO AVE SE
KENTWOOD MI
49508-6416
US

V. Phone/Fax

Practice location:
  • Phone: 616-813-2605
  • Fax: 616-827-0446
Mailing address:
  • Phone: 616-813-2605
  • Fax: 616-827-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801092618
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092618
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: