Provider Demographics
NPI:1033651203
Name:AM GRAY CONSULTING
Entity Type:Organization
Organization Name:AM GRAY CONSULTING
Other - Org Name:REFLECTIONS IMAGE CENTER & SKINCARE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LASONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-337-3870
Mailing Address - Street 1:44125 WOODRIDGE PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6839
Mailing Address - Country:US
Mailing Address - Phone:703-539-6002
Mailing Address - Fax:703-439-2829
Practice Address - Street 1:44125 WOODRIDGE PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6839
Practice Address - Country:US
Practice Address - Phone:703-539-6002
Practice Address - Fax:703-439-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173992363LF0000X
IN28154063A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty