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General NPI Number Information
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NPI Number | 1467002147
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Entity Type | Organization
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Legal Business Name | HEATHER GRAY PROFESSIONAL COUNSELING LLC
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 45739 HOLMES DR
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City | CANTON
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State | MI
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Zip | 48187-1616
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Country | US
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Telephone | 734-926-5610
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Fax |
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Provider Business Mailing Address
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Address Line | 45739 HOLMES DR
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City | CANTON
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State | MI
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Zip | 48187-1616
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Country | US
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Telephone | 734-558-1958
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. HEATHER GRAY
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Credential | MA, LPC, NCC
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Telephone | 734-558-1958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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