Provider Demographics
NPI:1013592500
Name:GRAY, ASHANTI (MS)
Entity Type:Individual
Prefix:
First Name:ASHANTI
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 S LINDEN RD STE D
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5474
Mailing Address - Country:US
Mailing Address - Phone:810-529-2731
Mailing Address - Fax:810-715-9705
Practice Address - Street 1:1409 ERIN LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2293
Practice Address - Country:US
Practice Address - Phone:216-470-4739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor