Healthcare Provider Details

I. General information

NPI: 1770074239
Provider Name (Legal Business Name): ANDRE R MCCRAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1293 COPLEY RD
AKRON OH
44320-2766
US

IV. Provider business mailing address

811 FREDERICK BLVD
AKRON OH
44320-1717
US

V. Phone/Fax

Practice location:
  • Phone: 330-374-1199
  • Fax: 330-374-0151
Mailing address:
  • Phone: 330-858-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: