Healthcare Provider Details

I. General information

NPI: 1710596630
Provider Name (Legal Business Name): EMILY MCCRAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 E PATRICK HENRY HWY
BURKEVILLE VA
23922-3454
US

IV. Provider business mailing address

214 BUSH RIVER DR
FARMVILLE VA
23901-3179
US

V. Phone/Fax

Practice location:
  • Phone: 434-767-7020
  • Fax:
Mailing address:
  • Phone: 434-392-3187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701009657
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: