Provider Demographics
NPI:1811470305
Name:MCGHEE, WILLIE FRED JR (LCASA)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:FRED
Last Name:MCGHEE
Suffix:JR
Gender:M
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-6804
Mailing Address - Country:US
Mailing Address - Phone:336-886-5594
Mailing Address - Fax:336-886-4160
Practice Address - Street 1:102 CHESTNUT DRIVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-6804
Practice Address - Country:US
Practice Address - Phone:336-886-5594
Practice Address - Fax:336-886-4160
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22414101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)