Provider Demographics
NPI:1912204272
Name:MCCRAE - EDGECOMBE, TAMEKA (LPC)
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:
Last Name:MCCRAE - EDGECOMBE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 WINTER VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7799
Mailing Address - Country:US
Mailing Address - Phone:678-577-4731
Mailing Address - Fax:
Practice Address - Street 1:525 WINTER VIEW WAY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7799
Practice Address - Country:US
Practice Address - Phone:678-577-4731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 102X00000X
GALPC 005626101YP2500X
GACSC434962101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist