Healthcare Provider Details

I. General information

NPI: 1578169629
Provider Name (Legal Business Name): WRAY OF LIGHT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W GRAND RIVER AVE STE A
OKEMOS MI
48864-1604
US

IV. Provider business mailing address

3303 ARBOR DR
FENTON MI
48430-3127
US

V. Phone/Fax

Practice location:
  • Phone: 313-403-4357
  • Fax: 877-860-2416
Mailing address:
  • Phone: 313-403-4357
  • Fax: 877-860-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE WRAY
Title or Position: OWNER
Credential: LMSW
Phone: 313-403-4357