Provider Demographics
NPI:1134574130
Name:MCRAE, LAURA VANDY (LCMHC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:VANDY
Last Name:MCRAE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 STAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-5906
Mailing Address - Country:US
Mailing Address - Phone:910-995-6817
Mailing Address - Fax:910-997-5290
Practice Address - Street 1:2202 FAYETTEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379
Practice Address - Country:US
Practice Address - Phone:910-995-2389
Practice Address - Fax:910-997-5290
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NC12256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional