MEDICARE: KELLY KNAPP MCCRAY LCMHCA

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	A18582	NC

General Provider Information

NPI Number	:	1952000234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY KNAPP MCCRAY LCMHCA

Provider Business Mailing Address
First Line	:	115 ANDERSON AVE
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445-1404
Country	:	US
Telephone Number	:	910-541-1131
Fax Number	:

Provider Business Practice Location Address
First Line	:	13500 NC HIGHWAY 50 STE 218
Second Line	:
City	:	SURF CITY
State	:	NC
Zip	:	28445-7934
Country	:	US
Telephone Number	:	910-541-1131
Fax Number	:

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

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	02/27/2023

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