Provider Demographics
NPI:1740630318
Name:RAY, SANDRA L
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SANDEE
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:915 INTERSTATE RIDGE DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-7076
Mailing Address - Country:US
Mailing Address - Phone:678-207-2900
Mailing Address - Fax:
Practice Address - Street 1:915 INTERSTATE RIDGE DR
Practice Address - Street 2:SUITE G
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7076
Practice Address - Country:US
Practice Address - Phone:678-207-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional