Provider Demographics
NPI:1982871059
Name:RAY, JEANETTE MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:MARIE
Last Name:RAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MARGARET AVE NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1306
Mailing Address - Country:US
Mailing Address - Phone:770-422-2009
Mailing Address - Fax:770-428-0330
Practice Address - Street 1:11755 POINTE PL
Practice Address - Street 2:SUITE A-1
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4636
Practice Address - Country:US
Practice Address - Phone:770-667-1264
Practice Address - Fax:770-667-2238
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health