Provider Demographics
NPI:1619570454
Name:WRAY, ROLANDA ASHLEY (LICSW)
Entity Type:Individual
Prefix:
First Name:ROLANDA
Middle Name:ASHLEY
Last Name:WRAY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 QUINCY ST NW APT 3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5777
Mailing Address - Country:US
Mailing Address - Phone:240-319-8796
Mailing Address - Fax:
Practice Address - Street 1:16110 ALDERWOOD LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1506
Practice Address - Country:US
Practice Address - Phone:202-641-4160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500824591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty