MEDICARE: NICOLE L CRAIG MA, LPC, CADCI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1144534561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE L CRAIG MA, LPC, CADCI

Provider Business Mailing Address
First Line	:	2027 SE JEFFERSON ST STE 205C
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97222-7691
Country	:	US
Telephone Number	:	503-444-9948
Fax Number	:

Provider Business Practice Location Address
First Line	:	2027 SE JEFFERSON ST STE 205C
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97222-7691
Country	:	US
Telephone Number	:	503-444-9948
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2010
Last Update Date	:	07/21/2022

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