Provider Demographics
NPI:1972102069
Name:RAY, LACRETIA DENISE (LICENSED MASSAGE THE)
Entity type:Individual
Prefix:MRS
First Name:LACRETIA
Middle Name:DENISE
Last Name:RAY
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W COPENHAVER DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-9549
Mailing Address - Country:US
Mailing Address - Phone:910-385-1157
Mailing Address - Fax:
Practice Address - Street 1:310 W COPENHAVER DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-9549
Practice Address - Country:US
Practice Address - Phone:910-385-1157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12505225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist