MEDICARE: HAROLD W MCRAE JR

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	106H00000X	Marriage & Family Therapist	MFT000330	GA
2	101Y00000X	Counselor	LPC 000765	GA

General Provider Information

NPI Number	:	1982770053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAROLD W MCRAE JR

Provider Business Mailing Address
First Line	:	1661 13TH STREET
Second Line	:	SUITE 102
City	:	COLUMBUS
State	:	GA
Zip	:	31901-3844
Country	:	US
Telephone Number	:	706-323-6123
Fax Number	:	706-324-2088

Provider Business Practice Location Address
First Line	:	1661 13TH STREET
Second Line	:	SUITE 102
City	:	COLUMBUS
State	:	GA
Zip	:	31901-3844
Country	:	US
Telephone Number	:	706-323-6123
Fax Number	:	706-324-2088

Authorized Official
Title or Position	:	OWNER
Name	:	HAROLD W MCRAE JR.
Credential	:	MD
Telephone Number	:	706-323-6123

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	09/11/2025

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