Provider Demographics
NPI:1073340741
Name:MCCRORIE, KATHRYN JANE
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JANE
Last Name:MCCRORIE
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:GLENRIDGE 400 OFFICE PARK
Mailing Address - Street 2:5825 GLENRIDGE DRIVE, BUILDING 2, SUITE 110
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:678-439-6564
Mailing Address - Fax:
Practice Address - Street 1:GLENRIDGE 400 OFFICE PARK
Practice Address - Street 2:5825 GLENRIDGE DRIVE, BUILDING 2, SUITE 110
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:678-439-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014985101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health