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General NPI Number Information
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NPI Number | 1194034041
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Entity Type | Individual
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Provider Name | ELLA MAE GRAY M.A., LCPC
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Gender | Female
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 04/27/2018
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Provider Practice Location Address
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Address Line | 957 RUSSELL AVE STE A
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City | GAITHERSBURG
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State | MD
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Zip | 20879-6216
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Country | US
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Telephone | 301-990-2777
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Fax | 301-990-3999
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Provider Business Mailing Address
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Address Line | 957 RUSSELL AVE STE A
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City | GAITHERSBURG
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State | MD
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Zip | 20879-6216
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Country | US
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Telephone | 301-990-2777
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Fax | 301-990-3999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC-4709
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License Number State | MD
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