Provider Demographics
NPI:1245790518
Name:RAY, LACEY CAIRISTIN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:CAIRISTIN
Last Name:RAY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 HICKORY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8752
Mailing Address - Country:US
Mailing Address - Phone:678-628-3920
Mailing Address - Fax:
Practice Address - Street 1:299 HICKORY LAKE DR
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8752
Practice Address - Country:US
Practice Address - Phone:678-628-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-3360103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst