Provider Demographics
NPI:1073707410
Name:GRAY, JANICE (LPC, CEAP, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPC, CEAP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 KINGSLEY LN STE 206
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4616
Mailing Address - Country:US
Mailing Address - Phone:757-398-2374
Mailing Address - Fax:757-889-6824
Practice Address - Street 1:110 KINGSLEY LN STE 206
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4616
Practice Address - Country:US
Practice Address - Phone:757-398-2374
Practice Address - Fax:757-889-3439
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA22757101YA0400X, 101YP2500X
VA0710000409101YA0400X
VA0701001710101YP2500X
VA0717000709106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist