Provider Demographics
NPI:1831467992
Name:CONNER, RAYMOND C SR
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:C
Last Name:CONNER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NEW LIFE
Other - Middle Name:
Other - Last Name:COUNSELING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:108 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-9010
Mailing Address - Country:US
Mailing Address - Phone:252-241-7395
Mailing Address - Fax:
Practice Address - Street 1:1185 HIBBS RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-9129
Practice Address - Country:US
Practice Address - Phone:252-241-7395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional