MEDICARE: TEAYRA GRAY LPC, LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LC13529	MD
2	101YP2500X	Professional Counselor	0701013998	VA
3	101YP2500X	Professional Counselor	PRC200001445	DC

General Provider Information

NPI Number	:	1801547286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEAYRA GRAY LPC, LCPC

Provider Business Mailing Address
First Line	:	440 MONTICELLO AVE
Second Line	:	SUITE 1802, PMB 997355
City	:	NORFOLK
State	:	VA
Zip	:	23510-2670
Country	:	US
Telephone Number	:	202-257-6274
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 MONTICELLO AVE
Second Line	:	SUITE 1802, PMB 997355
City	:	NORFOLK
State	:	VA
Zip	:	23510-2670
Country	:	US
Telephone Number	:	202-257-6274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2022
Last Update Date	:	07/28/2025

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