Provider Demographics
NPI:1942189840
Name:MCCRUM, KENYA VIRGINIA
Entity type:Individual
Prefix:
First Name:KENYA
Middle Name:VIRGINIA
Last Name:MCCRUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23398 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:DOLLAR BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49922-9730
Mailing Address - Country:US
Mailing Address - Phone:906-299-2027
Mailing Address - Fax:
Practice Address - Street 1:901 W MEM DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-2475
Practice Address - Country:US
Practice Address - Phone:906-482-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician