Provider Demographics
NPI:1134701675
Name:MCRAE, MOLLIE JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:JANE
Last Name:MCRAE
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 1:200 MASON ST STE 11
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-7061
Mailing Address - Country:US
Mailing Address - Phone:608-888-9291
Mailing Address - Fax:
Practice Address - Street 1:200 MASON ST STE 11
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-7061
Practice Address - Country:US
Practice Address - Phone:608-888-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9673-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical