Provider Demographics
NPI:1609325083
Name:KATHRYN D RAY, PLLC
Entity type:Organization
Organization Name:KATHRYN D RAY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:304-707-6170
Mailing Address - Street 1:631 CLOVERDALE RD.
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414
Mailing Address - Country:US
Mailing Address - Phone:304-707-6170
Mailing Address - Fax:
Practice Address - Street 1:113 W LIBERTY ST
Practice Address - Street 2:ROOM 208
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1547
Practice Address - Country:US
Practice Address - Phone:304-707-6170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009439131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty