Provider Demographics
NPI:1093337669
Name:MCRAE, YOULANDA LATASHA
Entity Type:Individual
Prefix:
First Name:YOULANDA
Middle Name:LATASHA
Last Name:MCRAE
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 1:23 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3042
Mailing Address - Country:US
Mailing Address - Phone:785-209-0905
Mailing Address - Fax:
Practice Address - Street 1:23 VICTORIA DR
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-3042
Practice Address - Country:US
Practice Address - Phone:785-209-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-17
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician