Provider Demographics
NPI:1346948759
Name:MCCRIMMON, KYERA KAY
Entity Type:Individual
Prefix:
First Name:KYERA
Middle Name:KAY
Last Name:MCCRIMMON
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 1:1533 ELLIS RD APT G301
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6391
Mailing Address - Country:US
Mailing Address - Phone:919-576-4200
Mailing Address - Fax:
Practice Address - Street 1:110 IOWA LN STE 104
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4493
Practice Address - Country:US
Practice Address - Phone:919-630-5668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NCA19516101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician