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General NPI Number Information
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NPI Number | 1508873944
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Entity Type | Individual
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Provider Name | SANDRA JEAN GRAY MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 500 MINTON HOLLOW RD
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City | ELIZABETHTON
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State | TN
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Zip | 37643-7906
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Country | US
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Telephone | 423-202-1969
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Fax | 423-373-1308
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Provider Business Mailing Address
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Address Line | PO BOX 1108
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City | ELIZABETHTON
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State | TN
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Zip | 37644-1108
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Country | US
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Telephone | 423-202-1969
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Fax | 423-373-1308
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4554
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License Number State | TN
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