Healthcare Provider Details

I. General information

NPI: 1689092918
Provider Name (Legal Business Name): ANNMARIE GRAY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E MAIN ST STE 2
MOORESTOWN NJ
08057-3079
US

IV. Provider business mailing address

26 S CEDAR AVE
MAPLE SHADE NJ
08052-1710
US

V. Phone/Fax

Practice location:
  • Phone: 848-702-1033
  • Fax:
Mailing address:
  • Phone: 848-702-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC020645
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01186600
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13422
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: