Healthcare Provider Details

I. General information

NPI: 1417609959
Provider Name (Legal Business Name): LAUREN GRAY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3904 OLEANDER DR STE 102
WILMINGTON NC
28403-6735
US

IV. Provider business mailing address

PO BOX 1637
OWENSBORO KY
42302-1637
US

V. Phone/Fax

Practice location:
  • Phone: 910-313-3232
  • Fax: 910-313-6598
Mailing address:
  • Phone: 704-232-2202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3914
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: