Provider Demographics
NPI:1043589997
Name:ADDISON, JOHN RAY (LPC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAY
Last Name:ADDISON
Suffix:
Gender:M
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:PO BOX 1105
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29633-1105
Mailing Address - Country:US
Mailing Address - Phone:864-882-7600
Mailing Address - Fax:864-882-7631
Practice Address - Street 1:530 BY PASS 123
Practice Address - Street 2:SUITE E2
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0859
Practice Address - Country:US
Practice Address - Phone:864-882-7600
Practice Address - Fax:864-882-7631
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1844101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional