Provider Demographics
NPI:1548425663
Name:RAY, CLEVELAND CARROLL (LPCMH)
Entity Type:Individual
Prefix:MR
First Name:CLEVELAND
Middle Name:CARROLL
Last Name:RAY
Suffix:
Gender:M
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17527 NASSAU COMMONS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-6283
Mailing Address - Country:US
Mailing Address - Phone:302-363-8835
Mailing Address - Fax:
Practice Address - Street 1:17527 NASSAU COMMONS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6283
Practice Address - Country:US
Practice Address - Phone:302-363-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional