Provider Demographics
NPI:1982770053
Name:HAROLD W MCRAE JR
Entity Type:Organization
Organization Name:HAROLD W MCRAE JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:706-323-6123
Mailing Address - Street 1:1661 13TH STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3844
Mailing Address - Country:US
Mailing Address - Phone:706-323-6123
Mailing Address - Fax:706-324-2088
Practice Address - Street 1:1661 13TH STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3844
Practice Address - Country:US
Practice Address - Phone:706-323-6123
Practice Address - Fax:706-324-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 000765101Y00000X
GAMFT000330106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty