Basic Information
Provider Information
NPI: 1003156159
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCRAE
FirstName: SHEILA
MiddleName: RENEE
NamePrefix: MS.
NameSuffix:  
Credential: LCASA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 883
Address2:  
City: WELDON
State: NC
PostalCode: 278900883
CountryCode: US
TelephoneNumber: 2525323666
FaxNumber:  
Practice Location
Address1: 608 JACKSON ST STE B
Address2:  
City: ROANOKE RAPIDS
State: NC
PostalCode: 278702656
CountryCode: US
TelephoneNumber: 2525323666
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/27/2013
LastUpdateDate: 03/09/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X NCN Behavioral Health & Social Service ProvidersCounselor 
101YA0400X NCN Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
101YA0400X3259-ANCY Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)

No ID Information.


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