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General NPI Number Information
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NPI Number | 1720862584
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Entity Type | Individual
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Provider Name | ALISSA GRAY MA
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Gender | Female
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 1676 MARYLAND AVE NE APT 470E
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City | WASHINGTON
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State | DC
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Zip | 20002-7675
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Country | US
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Telephone | 828-505-5366
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Fax |
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Provider Business Mailing Address
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Address Line | 8242 BROOKSTONE LN
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City | CLARKSTON
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State | MI
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Zip | 48348-4474
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Country | US
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Telephone | 828-505-5366
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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 | 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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