Healthcare Provider Details

I. General information

NPI: 1982770053
Provider Name (Legal Business Name): HAROLD W MCRAE JR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 13TH STREET SUITE 102
COLUMBUS GA
31901-3844
US

IV. Provider business mailing address

1661 13TH STREET SUITE 102
COLUMBUS GA
31901-3844
US

V. Phone/Fax

Practice location:
  • Phone: 706-323-6123
  • Fax: 706-324-2088
Mailing address:
  • Phone: 706-323-6123
  • Fax: 706-324-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT000330
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC 000765
License Number StateGA

VIII. Authorized Official

Name: HAROLD W MCRAE JR.
Title or Position: OWNER
Credential: MD
Phone: 706-323-6123