Provider Demographics
NPI:1063466498
Name:MCCRACKEN, GARNETTE DAWN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GARNETTE
Middle Name:DAWN
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6375 W CHARLESTON BLVD
Mailing Address - Street 2:A-100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1139
Mailing Address - Country:US
Mailing Address - Phone:702-253-0818
Mailing Address - Fax:702-253-9625
Practice Address - Street 1:6375 W CHARLESTON BLVD
Practice Address - Street 2:A-100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1139
Practice Address - Country:US
Practice Address - Phone:702-253-0818
Practice Address - Fax:702-253-9625
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4944-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical