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General NPI Number Information
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NPI Number | 1003974445
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Entity Type | Individual
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Provider Name | JANIS C RAYNOR LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 300 W HOSPITAL RD DDEAMC
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City | FORT GORDON
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State | GA
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Zip | 30905-5741
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Country | US
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Telephone | 706-787-9186
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Fax | 706-787-3562
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Provider Business Mailing Address
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Address Line | 300 W HOSPITAL RD # 13A-10 DDEAMC
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City | FORT GORDON
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State | GA
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Zip | 30905-5741
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Country | US
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Telephone | 706-787-9186
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Fax | 706-787-8991
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 38409
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License Number State | TX
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