Healthcare Provider Details

I. General information

NPI: 1285550608
Provider Name (Legal Business Name): ANTONY MCRAE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 MICAHS WAY N
SPRING LAKE NC
28390-2856
US

IV. Provider business mailing address

1128 MICAHS WAY N
SPRING LAKE NC
28390-2856
US

V. Phone/Fax

Practice location:
  • Phone: 910-302-9017
  • Fax:
Mailing address:
  • Phone: 910-302-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023647
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: