Provider Demographics
NPI:1376087510
Name:RAY, DIANA DODSON (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:DODSON
Last Name:RAY
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7619 LEESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4026
Mailing Address - Country:US
Mailing Address - Phone:919-691-5409
Mailing Address - Fax:
Practice Address - Street 1:100 W H ST
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-1605
Practice Address - Country:US
Practice Address - Phone:919-575-7620
Practice Address - Fax:919-575-7146
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22772101YA0400X
NCC0102301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)