Provider Demographics
NPI:1730354341
Name:MCCRARY, ED L (LCAS, CCS)
Entity type:Individual
Prefix:
First Name:ED
Middle Name:L
Last Name:MCCRARY
Suffix:
Gender:M
Credentials:LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-4904
Mailing Address - Country:US
Mailing Address - Phone:828-855-9595
Mailing Address - Fax:828-855-9599
Practice Address - Street 1:323 2ND ST NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4904
Practice Address - Country:US
Practice Address - Phone:828-855-9595
Practice Address - Fax:828-855-9599
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-164101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC45-3137563OtherTAX ID