Provider Demographics
NPI:1538450796
Name:RAY, DEBORAH (LPC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 PHOENIX BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5552
Mailing Address - Country:US
Mailing Address - Phone:770-997-1738
Mailing Address - Fax:770-991-1375
Practice Address - Street 1:101 DEVANT ST STE 1001
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2719
Practice Address - Country:US
Practice Address - Phone:770-997-1738
Practice Address - Fax:770-991-1375
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional