Provider Demographics
NPI:1346868494
Name:MCCRAY, TAHESHA
Entity Type:Individual
Prefix:
First Name:TAHESHA
Middle Name:
Last Name:MCCRAY
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:PO BOX 6497
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07206-9497
Mailing Address - Country:US
Mailing Address - Phone:908-414-2369
Mailing Address - Fax:
Practice Address - Street 1:23 LEFFERET STREET
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008
Practice Address - Country:US
Practice Address - Phone:908-414-2369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health