Provider Demographics
NPI:1003454224
Name:GRAY, CARLTON WAYNE JR
Entity Type:Individual
Prefix:MR
First Name:CARLTON
Middle Name:WAYNE
Last Name:GRAY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 PENSACOLA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814-7194
Mailing Address - Country:US
Mailing Address - Phone:225-305-5760
Mailing Address - Fax:
Practice Address - Street 1:3801 CANAL ST STE 325
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6059
Practice Address - Country:US
Practice Address - Phone:504-483-3558
Practice Address - Fax:504-525-4483
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health