Provider Demographics
NPI:1750977203
Name:HARRIS-MCCRAY, JUSTINA M (AAC)
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:M
Last Name:HARRIS-MCCRAY
Suffix:
Gender:F
Credentials:AAC
Other - Prefix:
Other - First Name:JUSTINA
Other - Middle Name:M
Other - Last Name:HARRIS-MCCRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JUSTINA MCCRAY
Mailing Address - Street 1:3321 W KENNEWICK AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2968
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3321 W KENNEWICK AVE STE 150
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2968
Practice Address - Country:US
Practice Address - Phone:509-735-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor