Provider Demographics
NPI:1184634842
Name:GRAY, RONNIE L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:L
Last Name:GRAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VETERANS AFFAIRS MEDICAL CTR
Mailing Address - Street 2:1201 BROAD ROCK BLVD.
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23249-0001
Mailing Address - Country:US
Mailing Address - Phone:804-675-5000
Mailing Address - Fax:804-675-6830
Practice Address - Street 1:VETERANS AFFAIRS MEDICAL CTR
Practice Address - Street 2:1201 BROAD ROCK BLVD.
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:804-675-6830
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040020611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical