Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 178-002678 | IL |
NPI | 1003035254 |
---|---|
Provider Name | Carrie A Ray |
First Address | Decatur, IL 62525-0710 |
Second Address | Decatur, IL 62523-1206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 10/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
178-002678 | LPC LICENSURE (01) | IL |