Provider Demographics
NPI:1679261374
Name:MCRAE, TINAYA ALEXIS
Entity Type:Individual
Prefix:
First Name:TINAYA
Middle Name:ALEXIS
Last Name:MCRAE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 LEGION DR
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-6211
Mailing Address - Country:US
Mailing Address - Phone:843-245-0618
Mailing Address - Fax:
Practice Address - Street 1:138 LEGION DR
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-6211
Practice Address - Country:US
Practice Address - Phone:843-245-0618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7971235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist