Provider Demographics
NPI:1053606814
Name:RATIA, JAY M (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:M
Last Name:RATIA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 BOWDEN DR
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-8828
Mailing Address - Country:US
Mailing Address - Phone:919-529-2452
Mailing Address - Fax:
Practice Address - Street 1:4509 CREEDMOOR RD STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3813
Practice Address - Country:US
Practice Address - Phone:984-999-1213
Practice Address - Fax:877-673-1424
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X
NCC0072231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral