Healthcare Provider Details

I. General information

NPI: 1487343281
Provider Name (Legal Business Name): ARIANA GRAY ED.S., NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 LANDAU RD
JACKSONVILLE FL
32225-8275
US

IV. Provider business mailing address

1492 LANDAU RD
JACKSONVILLE FL
32225-8275
US

V. Phone/Fax

Practice location:
  • Phone: 772-579-1168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: