Provider Demographics
NPI:1689443921
Name:MCRAE, RAHEEN
Entity Type:Individual
Prefix:
First Name:RAHEEN
Middle Name:
Last Name:MCRAE
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 1:407 TORI DR STE 2
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-5209
Mailing Address - Country:US
Mailing Address - Phone:770-800-0891
Mailing Address - Fax:
Practice Address - Street 1:407 TORI DR STE 2
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-5209
Practice Address - Country:US
Practice Address - Phone:770-800-0891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician