Provider Demographics
NPI:1124324462
Name:RAY, ERICA A (C1000364)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:A
Last Name:RAY
Suffix:
Gender:F
Credentials:C1000364
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 W BOWERY ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-2598
Mailing Address - Country:US
Mailing Address - Phone:330-996-4600
Mailing Address - Fax:330-643-0767
Practice Address - Street 1:282 W BOWERY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2598
Practice Address - Country:US
Practice Address - Phone:330-996-4600
Practice Address - Fax:330-643-0767
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1000364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health