Provider Demographics
NPI:1952000234
Name:MCCRAY, KELLY KNAPP (LCMHCA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:KNAPP
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-1404
Mailing Address - Country:US
Mailing Address - Phone:910-541-1131
Mailing Address - Fax:
Practice Address - Street 1:13500 NC HIGHWAY 50 STE 218
Practice Address - Street 2:
Practice Address - City:SURF CITY
Practice Address - State:NC
Practice Address - Zip Code:28445-7934
Practice Address - Country:US
Practice Address - Phone:910-541-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health