Provider Demographics
NPI:1053678391
Name:RAY, KELLY L (LPC, CACII)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:RAY
Suffix:
Gender:F
Credentials:LPC, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 N MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5526
Mailing Address - Country:US
Mailing Address - Phone:864-225-0591
Mailing Address - Fax:
Practice Address - Street 1:907 N MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5526
Practice Address - Country:US
Practice Address - Phone:864-225-0591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10052010101YA0400X
SC5267101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)