Provider Demographics
NPI:1649093915
Name:PETTY, OUNDRAY P SR
Entity type:Individual
Prefix:
First Name:OUNDRAY
Middle Name:P
Last Name:PETTY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BRITTANY RD
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-1006
Mailing Address - Country:US
Mailing Address - Phone:864-237-1761
Mailing Address - Fax:
Practice Address - Street 1:1806 KINGSTON RD
Practice Address - Street 2:
Practice Address - City:KINGSTOWN
Practice Address - State:NC
Practice Address - Zip Code:28150-8663
Practice Address - Country:US
Practice Address - Phone:864-237-1761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty