Provider Demographics
NPI:1689407140
Name:MCCREARY, KHADIJA
Entity type:Individual
Prefix:
First Name:KHADIJA
Middle Name:
Last Name:MCCREARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5576 CAMBRIDGE BAY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6117
Mailing Address - Country:US
Mailing Address - Phone:704-299-8549
Mailing Address - Fax:
Practice Address - Street 1:5576 CAMBRIDGE BAY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-6117
Practice Address - Country:US
Practice Address - Phone:704-299-8549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health