Provider Demographics
NPI:1134499809
Name:GRAY, KATRINA MICHELLE (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MICHELLE
Last Name:GRAY
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 CLANTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1309
Mailing Address - Country:US
Mailing Address - Phone:704-332-9001
Mailing Address - Fax:704-295-4937
Practice Address - Street 1:150 DEN-MAC DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6543
Practice Address - Country:US
Practice Address - Phone:828-263-8171
Practice Address - Fax:828-263-0995
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NCLCAS-21371101YA0400X
NCC0114751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)