Provider Demographics
NPI:1093013641
Name:RAY, JUSTIN T (PMHNP)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:T
Last Name:RAY
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
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Mailing Address - Street 1:5265 PROVIDENCE RD STE 500
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4210
Mailing Address - Country:US
Mailing Address - Phone:757-467-9500
Mailing Address - Fax:757-467-9560
Practice Address - Street 1:224 GREAT BRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3904
Practice Address - Country:US
Practice Address - Phone:757-547-9334
Practice Address - Fax:757-819-6292
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2020-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0001204117363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health