Provider Demographics
NPI:1518332683
Name:RAY, KENNETH CHARLES (LCMHC, MAC, MAPC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:CHARLES
Last Name:RAY
Suffix:
Gender:M
Credentials:LCMHC, MAC, MAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 KEISLER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9321
Mailing Address - Country:US
Mailing Address - Phone:919-228-9162
Mailing Address - Fax:
Practice Address - Street 1:543 KEISLER DR STE 202
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9321
Practice Address - Country:US
Practice Address - Phone:919-228-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15870101YP2500X
NC11936101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional