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General NPI Number Information
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NPI Number | 1376934117
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Entity Type | Organization
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Legal Business Name | MARY C. RAY
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Dates
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Enumeration Date | 02/16/2015
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 201B S ROYAL ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3329
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Country | US
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Telephone | 703-683-0920
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Fax |
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Provider Business Mailing Address
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Address Line | 400 PRINCE ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3114
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Country | US
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Telephone | 703-683-0920
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MARY CATHERINE RAY
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Credential | LCSW,ACSW, SEP
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Telephone | 703-683-0920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0904001621
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License Number State | VA
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