Healthcare Provider Details

I. General information

NPI: 1932575016
Provider Name (Legal Business Name): ANDREW LEO GRAY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 WINN WAY
DECATUR GA
30030-1707
US

IV. Provider business mailing address

746 KELLEYTOWN RD
MCDONOUGH GA
30252-3910
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-7700
  • Fax:
Mailing address:
  • Phone: 770-957-4894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC014372
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: