Provider Demographics
NPI:1578704326
Name:RAY, KASHANDA SMITH (LPC)
Entity Type:Individual
Prefix:
First Name:KASHANDA
Middle Name:SMITH
Last Name:RAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 VODINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-9727
Mailing Address - Country:US
Mailing Address - Phone:318-235-7469
Mailing Address - Fax:
Practice Address - Street 1:1301 CAROLINA ST
Practice Address - Street 2:SUITE 114
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1032
Practice Address - Country:US
Practice Address - Phone:336-272-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-07
Last Update Date:2009-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7205101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor