Healthcare Provider Details

I. General information

NPI: 1548782501
Provider Name (Legal Business Name): GRAY MATTERS COUNSELING AND CONSULTING ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 CLEVELAND AVE
EAST POINT GA
30344-3425
US

IV. Provider business mailing address

3645 MARKETPLACE BLVD STE 130-129
EAST POINT GA
30344-5747
US

V. Phone/Fax

Practice location:
  • Phone: 770-899-6462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number007492
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number007492
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007492
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number007492
License Number StateGA

VIII. Authorized Official

Name: CASSAUNDRA GRAY
Title or Position: CEO
Credential:
Phone: 770-899-6462