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General NPI Number Information
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NPI Number | 1881129716
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Entity Type | Organization
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Legal Business Name | KIYOI CRAIG LMSW LLC
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5890 KALAMAZOO AVE SE
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City | KENTWOOD
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State | MI
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Zip | 49508-6416
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Country | US
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Telephone | 616-813-2605
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Fax |
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Provider Business Mailing Address
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Address Line | 5890 KALAMAZOO AVE SE
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City | KENTWOOD
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State | MI
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Zip | 49508-6416
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Country | US
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Telephone | 616-813-2605
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Fax |
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Authorized Official
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Title or Position | LMSW-CLINICAL THERAPIST
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Name | KIYOI J CRAIG
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Credential | LMSW
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Telephone | 616-281-1803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801092618
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License Number State | MI
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