Provider Demographics
NPI:1073147310
Name:RAY, LEA CAMILLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LEA
Middle Name:CAMILLE
Last Name:RAY
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 1:6409 FAYETTEVILLE RD STE 120
Mailing Address - Street 2:#207
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2532
Mailing Address - Country:US
Mailing Address - Phone:561-319-6188
Mailing Address - Fax:
Practice Address - Street 1:5306 PELHAM RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2532
Practice Address - Country:US
Practice Address - Phone:561-319-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0087201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical