Provider Demographics
NPI:1609216738
Name:MCRAE, REGINALD HENRY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:HENRY
Last Name:MCRAE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13885 HEDGEWOOD DR STE 349
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-7933
Mailing Address - Country:US
Mailing Address - Phone:571-367-0653
Mailing Address - Fax:713-670-6595
Practice Address - Street 1:13885 HEDGEWOOD DR STE 349
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-7933
Practice Address - Country:US
Practice Address - Phone:571-367-0653
Practice Address - Fax:571-367-0659
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004799103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical