Healthcare Provider Details

I. General information

NPI: 1952000234
Provider Name (Legal Business Name): KELLY KNAPP MCCRAY LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 H2O PLACE, SUITE 1
HAMPSTEAD NC
28443
US

IV. Provider business mailing address

115 ANDERSON AVE
HOLLY RIDGE NC
28445-1404
US

V. Phone/Fax

Practice location:
  • Phone: 910-541-1131
  • Fax:
Mailing address:
  • Phone: 910-541-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18582
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: