MEDICARE: DOMINIQUE MARY MCCRAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1821223223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE MARY MCCRAY

Provider Business Mailing Address
First Line	:	7322 TRACY LN
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-3533
Country	:	US
Telephone Number	:	678-824-4125
Fax Number	:

Provider Business Practice Location Address
First Line	:	7322 TRACY LN
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-3533
Country	:	US
Telephone Number	:	678-824-4125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	03/25/2026

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