Provider Demographics
NPI:1013656495
Name:MCRAE, HENRY LAMONT
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:LAMONT
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 1:5213 OLD RAILROAD WAY
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-7868
Mailing Address - Country:US
Mailing Address - Phone:843-245-2221
Mailing Address - Fax:
Practice Address - Street 1:5213 OLD RAILROAD WAY
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-7868
Practice Address - Country:US
Practice Address - Phone:843-245-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0175541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical