Provider Demographics
NPI:1255697017
Name:THE MCCRAY CENTER, LLC
Entity type:Organization
Organization Name:THE MCCRAY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:229-317-4901
Mailing Address - Street 1:1216 DAWSON RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3889
Mailing Address - Country:US
Mailing Address - Phone:229-317-4901
Mailing Address - Fax:229-317-4902
Practice Address - Street 1:1216 DAWSON RD
Practice Address - Street 2:SUITE 209
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3889
Practice Address - Country:US
Practice Address - Phone:229-317-4901
Practice Address - Fax:229-317-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006221101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003106438AMedicaid