Provider Demographics
NPI:1104111467
Name:MCALLISTER-MCRAE, ROSA
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:
Last Name:MCALLISTER-MCRAE
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 1:120 SPRUCEPINE DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8452
Mailing Address - Country:US
Mailing Address - Phone:910-695-3725
Mailing Address - Fax:910-695-3981
Practice Address - Street 1:120 SPRUCEPINE DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-8452
Practice Address - Country:US
Practice Address - Phone:910-695-3725
Practice Address - Fax:910-695-3981
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4777101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health