Provider Demographics
NPI:1528364122
Name:MCCRAY, CARRIE A (LCPC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 WESTERN AVE
Mailing Address - Street 2:PMB #310
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7249
Mailing Address - Country:US
Mailing Address - Phone:207-228-1138
Mailing Address - Fax:207-228-1138
Practice Address - Street 1:126 WESTERN AVE
Practice Address - Street 2:PMB #310
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7249
Practice Address - Country:US
Practice Address - Phone:207-228-1138
Practice Address - Fax:207-228-1138
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3703101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional