Basic Information
| Provider Information | |||||||||
| NPI: | 1750594966 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAVER | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | PCC-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4874 FAIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | NEWTON FALLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444449503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308726427 | ||||||||
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| Practice Location | |||||||||
| Address1: | 165 E PARK AVE | ||||||||
| Address2: | |||||||||
| City: | NILES | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444462352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305448005 | ||||||||
| FaxNumber: | 3305449379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E0003846 | OH | X | Behavioral Health & Social Service Providers | Counselor | Professional | 101YS0200X | OH1-49-8631 | OH | X | Behavioral Health & Social Service Providers | Counselor | School |
No ID Information.