Provider Demographics
NPI:1437908068
Name:STEPHENS, CRAIG W II
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:W
Last Name:STEPHENS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32014 N MARGINAL DR APT 384
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-4478
Mailing Address - Country:US
Mailing Address - Phone:216-336-3312
Mailing Address - Fax:
Practice Address - Street 1:32014 N MARGINAL DR APT 384
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-4478
Practice Address - Country:US
Practice Address - Phone:216-336-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health