Healthcare Provider Details

I. General information

NPI: 1902152465
Provider Name (Legal Business Name): MEGAN ELIZABETH MCRAE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20905 PROFESSIONAL PLZ SUITE 220
ASHBURN VA
20147-7783
US

IV. Provider business mailing address

20905 PROFESSIONAL PLZ SUITE 220
ASHBURN VA
20147-7783
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-9841
  • Fax: 703-858-9446
Mailing address:
  • Phone: 703-858-9841
  • Fax: 703-858-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810004619
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: