Provider Demographics
NPI:1447611546
Name:MCCRAYHEAD, PHILANDER CAROL
Entity Type:Individual
Prefix:
First Name:PHILANDER
Middle Name:CAROL
Last Name:MCCRAYHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PHILANDER
Other - Middle Name:CAROL
Other - Last Name:MCCRAYHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:404 EL DESTINADO DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1607
Mailing Address - Country:US
Mailing Address - Phone:850-510-0915
Mailing Address - Fax:
Practice Address - Street 1:404 EL DESTINADO DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1607
Practice Address - Country:US
Practice Address - Phone:850-510-0915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst