Provider Demographics
NPI:1538783311
Name:RAY, NAEISHA LUCILLE (RBT)
Entity type:Individual
Prefix:
First Name:NAEISHA
Middle Name:LUCILLE
Last Name:RAY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:NAEISHA
Other - Middle Name:LUCILLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1260 TORREY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3954
Mailing Address - Country:US
Mailing Address - Phone:910-384-6624
Mailing Address - Fax:
Practice Address - Street 1:351 WAGONER DR STE 325
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4674
Practice Address - Country:US
Practice Address - Phone:910-491-0117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician