Provider Demographics
NPI:1568513380
Name:MCCRORY, CAROL ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:MCCRORY
Suffix:
Gender:F
Credentials:MA
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 3178
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-3178
Mailing Address - Country:US
Mailing Address - Phone:530-642-2479
Mailing Address - Fax:530-642-2479
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9109
Practice Address - Country:US
Practice Address - Phone:530-642-2479
Practice Address - Fax:530-642-2479
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT24033106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist