Basic Information
| Provider Information | |||||||||
| NPI: | 1508268517 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCRARY | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | WILSON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2359 US HIGHWAY 70 SE | ||||||||
| Address2: | # 357 | ||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286028300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043329001 | ||||||||
| FaxNumber: | 7043320124 | ||||||||
| Practice Location | |||||||||
| Address1: | 117 W MEDICAL CT | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287525590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286593966 | ||||||||
| FaxNumber: | 8286596304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2014 | ||||||||
| LastUpdateDate: | 03/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | P008238 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | C012101 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | P008238 | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.