Healthcare Provider Details

I. General information

NPI: 1811825680
Provider Name (Legal Business Name): JILLIAN LEEANN GRAY LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MARLTON PIKE E STE 27
CHERRY HILL NJ
08034-2207
US

IV. Provider business mailing address

41 N ROWAND AVE
RUNNEMEDE NJ
08078-1518
US

V. Phone/Fax

Practice location:
  • Phone: 856-448-4989
  • Fax:
Mailing address:
  • Phone: 856-693-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37AC00885100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: