Provider Demographics
NPI:1548772643
Name:RAY, TRAYCEEA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TRAYCEEA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-4006
Mailing Address - Country:US
Mailing Address - Phone:662-588-0025
Mailing Address - Fax:
Practice Address - Street 1:1106 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-4006
Practice Address - Country:US
Practice Address - Phone:662-588-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker