Provider Demographics
NPI:1306526298
Name:MCRAE, DIANE J (LICSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:MCRAE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:J
Other - Last Name:VOIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4420 125TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8750
Mailing Address - Country:US
Mailing Address - Phone:425-239-2538
Mailing Address - Fax:
Practice Address - Street 1:2901 174TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4743
Practice Address - Country:US
Practice Address - Phone:360-454-1922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601820991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical