Provider Demographics
NPI:1831242908
Name:RAY, ANDREA (LMHC, SUDP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:LMHC, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 W GRANDRIDGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6710
Mailing Address - Country:US
Mailing Address - Phone:509-554-6721
Mailing Address - Fax:509-357-8646
Practice Address - Street 1:7409 W GRANDRIDGE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6710
Practice Address - Country:US
Practice Address - Phone:208-503-3698
Practice Address - Fax:509-357-8646
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002514101YA0400X
WALH00007805101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1980267Medicaid