Basic Information
Provider Information
NPI: 1558725614
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCCRAY
FirstName: SHARESA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 284 EXECUTIVE PARK DR STE 100
Address2:  
City: CONCORD
State: NC
PostalCode: 280251833
CountryCode: US
TelephoneNumber: 7049391100
FaxNumber: 7049391120
Practice Location
Address1: 2129 STATESVILLE BLVD
Address2:  
City: SALISBURY
State: NC
PostalCode: 28147
CountryCode: US
TelephoneNumber: 7046333616
FaxNumber: 7046335902
Other Information
ProviderEnumerationDate: 04/05/2016
LastUpdateDate: 09/07/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XP009539NCY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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