Provider Demographics
NPI:1003974445
Name:RAYNOR, JANIS C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANIS
Middle Name:C
Last Name:RAYNOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W HOSPITAL RD # 13A-10
Mailing Address - Street 2:DDEAMC
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-9186
Mailing Address - Fax:706-787-8991
Practice Address - Street 1:300 W HOSPITAL RD
Practice Address - Street 2:DDEAMC
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-9186
Practice Address - Fax:706-787-3562
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX384091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38409OtherLCSW-C