Provider Demographics
NPI:1003068529
Name:GRAY, GENEVA MARIE (PHD, LPC, NCC, CPCS)
Entity Type:Individual
Prefix:DR
First Name:GENEVA
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:PHD, LPC, NCC, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 SCENIC HWY S
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3115
Mailing Address - Country:US
Mailing Address - Phone:770-559-9919
Mailing Address - Fax:404-891-5095
Practice Address - Street 1:2330 SCENIC HWY S
Practice Address - Street 2:SUITE 115
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3115
Practice Address - Country:US
Practice Address - Phone:770-559-9919
Practice Address - Fax:404-891-5095
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0004236101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA922721756BMedicaid