Provider Demographics
NPI:1659914034
Name:MCRAE, KIYA (LCSWA)
Entity Type:Individual
Prefix:
First Name:KIYA
Middle Name:
Last Name:MCRAE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 MAYODAN DR APT 308
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0491
Mailing Address - Country:US
Mailing Address - Phone:910-409-4256
Mailing Address - Fax:
Practice Address - Street 1:324 PERSON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5736
Practice Address - Country:US
Practice Address - Phone:910-438-0939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO132421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical