Provider Demographics
NPI:1285996371
Name:WRAY, SHAWANNA YVETTE
Entity type:Individual
Prefix:MS
First Name:SHAWANNA
Middle Name:YVETTE
Last Name:WRAY
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 1:5156 FLAY RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-0793
Mailing Address - Country:US
Mailing Address - Phone:336-327-0959
Mailing Address - Fax:
Practice Address - Street 1:166 W FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4107
Practice Address - Country:US
Practice Address - Phone:704-864-1001
Practice Address - Fax:704-864-6050
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst