Provider Demographics
NPI:1245675859
Name:CRAIG, LAKOYA GRATIC
Entity type:Individual
Prefix:MRS
First Name:LAKOYA
Middle Name:GRATIC
Last Name:CRAIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 OSPREY NEST CT
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8024
Mailing Address - Country:US
Mailing Address - Phone:803-381-7549
Mailing Address - Fax:
Practice Address - Street 1:132 OSPREY NEST CT
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-8024
Practice Address - Country:US
Practice Address - Phone:803-381-7549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87522174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist