Provider Demographics
NPI:1457050551
Name:MCCRAE, LAQUITA
Entity Type:Individual
Prefix:
First Name:LAQUITA
Middle Name:
Last Name:MCCRAE
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 1:418 OLD KESWICK LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23805-7867
Mailing Address - Country:US
Mailing Address - Phone:434-885-8915
Mailing Address - Fax:
Practice Address - Street 1:418 OLD KESWICK LN
Practice Address - Street 2:
Practice Address - City:SOUTH PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23805-7867
Practice Address - Country:US
Practice Address - Phone:434-885-8915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities