Provider Demographics
NPI:1053646794
Name:GRAY, EKWENZI (PHD)
Entity Type:Individual
Prefix:DR
First Name:EKWENZI
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12138 CENTRAL AVE STE 176
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1910
Mailing Address - Country:US
Mailing Address - Phone:240-621-0215
Mailing Address - Fax:
Practice Address - Street 1:530 COLLEGE STREET NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-1810
Practice Address - Country:US
Practice Address - Phone:202-806-7981
Practice Address - Fax:202-806-9311
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000438103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical