Provider Demographics
NPI:1063654697
Name:BRAY, CHERYL BRAY (LPC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:BRAY
Last Name:BRAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:BRAY
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28111 ANNABELLE LANE
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526
Mailing Address - Country:US
Mailing Address - Phone:251-404-6929
Mailing Address - Fax:251-626-7728
Practice Address - Street 1:2401 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526
Practice Address - Country:US
Practice Address - Phone:251-404-6929
Practice Address - Fax:251-626-7728
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8429101YM0800X
AL1942101YP2500X
MS981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health