Provider Demographics
NPI:1003620287
Name:MCCRAY, ALICIA ANTONETTE
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANTONETTE
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 1:361 N UNIVERSITY DR APT 223
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2052
Mailing Address - Country:US
Mailing Address - Phone:843-359-1485
Mailing Address - Fax:
Practice Address - Street 1:361 N UNIVERSITY DR APT 223
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2052
Practice Address - Country:US
Practice Address - Phone:843-359-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty