Provider Demographics
NPI:1558171280
Name:MCCRAW, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:MCCRAW
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 1:214 WOODBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-7549
Mailing Address - Country:US
Mailing Address - Phone:336-648-1861
Mailing Address - Fax:
Practice Address - Street 1:390 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5260
Practice Address - Country:US
Practice Address - Phone:336-934-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician