Provider Demographics
NPI:1619227683
Name:RAY, GEENA D (LCSW)
Entity Type:Individual
Prefix:
First Name:GEENA
Middle Name:D
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 1:3091 ORDWAY DR NW
Mailing Address - Street 2:APT. F
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-1985
Mailing Address - Country:US
Mailing Address - Phone:540-968-6520
Mailing Address - Fax:
Practice Address - Street 1:3959 ELECTRIC RD
Practice Address - Street 2:SUITE 345
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4562
Practice Address - Country:US
Practice Address - Phone:540-904-6032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040080171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical