Healthcare Provider Details

I. General information

NPI: 1639758113
Provider Name (Legal Business Name): INTO THE GRAY COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 08/17/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 ESPEY COURT SUITE 2
CROFTON MD
21114
US

IV. Provider business mailing address

12138 CENTRAL AVE STE 176
MITCHELLVILLE MD
20721-1910
US

V. Phone/Fax

Practice location:
  • Phone: 202-810-4148
  • Fax:
Mailing address:
  • Phone: 202-810-4148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JOMO EKWENZI GRAY
Title or Position: CO-OWNER
Credential: PH.D.
Phone: 240-621-0215