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General NPI Number Information
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NPI Number | 1265152672
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Entity Type | Individual
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Provider Name | ANGELA MARIE GRAY MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 08/29/2022
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 18341 US HIGHWAY 41
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City | LANSE
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State | MI
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Zip | 49946-8024
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Country | US
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Telephone | 906-524-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 18217 2ND SAND BEACH RD
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City | LANSE
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State | MI
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Zip | 49946-8358
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Country | US
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Telephone | 254-592-7395
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401222843
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License Number State | MI
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