Provider Demographics
NPI:1538674098
Name:A RAY OF HOPE SUBSTANCE ABUSE COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:A RAY OF HOPE SUBSTANCE ABUSE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-413-0401
Mailing Address - Street 1:115 E MAIN ST STE 11
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-2482
Mailing Address - Country:US
Mailing Address - Phone:252-802-4135
Mailing Address - Fax:252-364-3425
Practice Address - Street 1:115 E MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2482
Practice Address - Country:US
Practice Address - Phone:252-802-4135
Practice Address - Fax:252-364-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health