Provider Demographics
NPI:1780768051
Name:MCCRARY, BETTY RHODES (PHD)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:RHODES
Last Name:MCCRARY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 OLD MILL DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-4615
Mailing Address - Country:US
Mailing Address - Phone:540-774-4686
Mailing Address - Fax:540-989-8893
Practice Address - Street 1:3635 MANASSAS DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-774-4686
Practice Address - Fax:540-989-8893
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001388101YP2500X
VA0717000592106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA$$$$$$$$$Medicare Oscar/Certification
VA$$$$$$$$$Medicare UPIN
VA$$$$$$$$$Medicare PIN