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Individual

MARK DOUGLAS RAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPC

Contact information

Practice address
1315 13TH AVE SE, DECATUR, AL 35601-4308
(256) 355-6105
Mailing address
1316 SOMERVILLE RD SE, SUITE 1, DECATUR, AL 35601-4305

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
822
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
051525472
BCBS OF AL PROVIDER #
AL
Enumeration date
12/05/2006
Last updated
10/23/2012
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