Provider Demographics
NPI:1801141429
Name:RAY, ERIN HARRELL (LCSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:HARRELL
Last Name:RAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 NAVAHO TRL
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1290
Mailing Address - Country:US
Mailing Address - Phone:470-583-6486
Mailing Address - Fax:
Practice Address - Street 1:1539 OLD VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:RAY CITY
Practice Address - State:GA
Practice Address - Zip Code:31645-7132
Practice Address - Country:US
Practice Address - Phone:877-755-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0042801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical