Provider Demographics
NPI:1558714667
Name:MCRAE, AQUICHA RENEE (LCSW-A)
Entity Type:Individual
Prefix:
First Name:AQUICHA
Middle Name:RENEE
Last Name:MCRAE
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 FIELDING PL
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-4007
Mailing Address - Country:US
Mailing Address - Phone:336-929-1586
Mailing Address - Fax:
Practice Address - Street 1:7 OAK BRANCH DR STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2392
Practice Address - Country:US
Practice Address - Phone:336-856-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0104591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical