Provider Demographics
NPI:1629106125
Name:MCCRACKEN, DOUG
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:MCCRACKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CROWNCREST RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-4895
Mailing Address - Country:US
Mailing Address - Phone:571-237-4556
Mailing Address - Fax:833-702-9006
Practice Address - Street 1:7051 HEATHCOTE VILLAGE WAY STE 125
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3198
Practice Address - Country:US
Practice Address - Phone:571-237-4556
Practice Address - Fax:833-702-9006
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004422101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor