Provider Demographics
NPI:1174257265
Name:JAMES, WILLIE RAY JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:RAY
Last Name:JAMES
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 KIRBY PL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3120
Mailing Address - Country:US
Mailing Address - Phone:912-217-8100
Mailing Address - Fax:
Practice Address - Street 1:610 KIRBY PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3120
Practice Address - Country:US
Practice Address - Phone:912-217-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health