Healthcare Provider Details

I. General information

NPI: 1639754237
Provider Name (Legal Business Name): VERONICA VANN-RAY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PROFESSIONAL PARK DR STE 13
JOHNSON CITY TN
37604-6584
US

IV. Provider business mailing address

133 FOXPORT RD
KINGSPORT TN
37664-5626
US

V. Phone/Fax

Practice location:
  • Phone: 423-952-6474
  • Fax:
Mailing address:
  • Phone: 423-480-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16321
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: