Healthcare Provider Details

I. General information

NPI: 1356255475
Provider Name (Legal Business Name): GUIDING RAY PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 RIDGEMONT AVE APT 2507
CHARLOTTE NC
28208-0179
US

IV. Provider business mailing address

2114 RIDGEMONT AVE APT 2507
CHARLOTTE NC
28208-0179
US

V. Phone/Fax

Practice location:
  • Phone: 704-868-1685
  • Fax:
Mailing address:
  • Phone: 704-868-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SUWILANJI KUEZINKE
Title or Position: SOLE MEMBER/OWNER
Credential: PSY.D
Phone: 678-751-9541