Provider Demographics
NPI:1184012734
Name:RAY, LILIAN
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 HIGHLAND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-3117
Mailing Address - Country:US
Mailing Address - Phone:170-460-1533
Mailing Address - Fax:170-460-1533
Practice Address - Street 1:547 HIGHLAND ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-3117
Practice Address - Country:US
Practice Address - Phone:170-460-1533
Practice Address - Fax:170-460-1533
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No291U00000XLaboratoriesClinical Medical Laboratory
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children