Provider Demographics
NPI:1508268517
Name:MCRARY, TINA WILSON (LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:WILSON
Last Name:MCRARY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2359 US HIGHWAY 70 SE
Mailing Address - Street 2:# 357
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8300
Mailing Address - Country:US
Mailing Address - Phone:704-332-9001
Mailing Address - Fax:704-332-0124
Practice Address - Street 1:117 W MEDICAL CT
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5590
Practice Address - Country:US
Practice Address - Phone:828-659-3966
Practice Address - Fax:828-659-6304
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP008238101YA0400X, 1041C0700X
NCC0121011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)