Basic Information
| Provider Information | |||||||||
| NPI: | 1003156159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCRAE | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCASA | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | NC | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 3259-A | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.