Healthcare Provider Details

I. General information

NPI: 1760939870
Provider Name (Legal Business Name): MRS. AMBER GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10055 RED RUN BLVD STE 200
OWINGS MILLS MD
21117-4867
US

IV. Provider business mailing address

10055 RED RUN BLVD STE 200
OWINGS MILLS MD
21117-4867
US

V. Phone/Fax

Practice location:
  • Phone: 443-722-4657
  • Fax:
Mailing address:
  • Phone: 443-722-4657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: