Provider Demographics
NPI:1922413988
Name:RAY, MARTIN (LAPC, CRC, MS)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:LAPC, CRC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 NORTHVIEW AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3231
Mailing Address - Country:US
Mailing Address - Phone:404-432-9053
Mailing Address - Fax:
Practice Address - Street 1:2150 PEACHFORD RD
Practice Address - Street 2:SUITE Q
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6520
Practice Address - Country:US
Practice Address - Phone:678-615-7032
Practice Address - Fax:678-281-0592
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health