Provider Demographics
NPI:1225584691
Name:RAY-COUNCIL, MARY (LCAS-A, CSAC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:RAY-COUNCIL
Suffix:
Gender:F
Credentials:LCAS-A, CSAC
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:LOUISE
Other - Last Name:RAY-COUNCIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCAS-A, CSAC
Mailing Address - Street 1:2011 LILLIAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-7717
Mailing Address - Country:US
Mailing Address - Phone:919-333-1126
Mailing Address - Fax:919-872-1455
Practice Address - Street 1:2011 LILLIAN DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-7717
Practice Address - Country:US
Practice Address - Phone:919-333-1126
Practice Address - Fax:919-872-1455
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-22802101YA0400X
NCCSAC-2998101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)