Provider Demographics
NPI:1053641597
Name:MCCRAW, ANNA JANELLE (LAC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:JANELLE
Last Name:MCCRAW
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E CENTERTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-9240
Mailing Address - Country:US
Mailing Address - Phone:479-795-1802
Mailing Address - Fax:479-795-1805
Practice Address - Street 1:250 E CENTERTON BLVD
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-9240
Practice Address - Country:US
Practice Address - Phone:479-795-1802
Practice Address - Fax:479-795-1805
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator