Provider Demographics
NPI:1891013314
Name:MCCRAY, JESSICA
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:MCCRAY
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 1:21 NATIONAL GUARD RD
Mailing Address - Street 2:APT 532
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-4765
Mailing Address - Country:US
Mailing Address - Phone:630-346-6521
Mailing Address - Fax:
Practice Address - Street 1:21 NATIONAL GUARD RD
Practice Address - Street 2:APT 532
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-4765
Practice Address - Country:US
Practice Address - Phone:630-346-6521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker