Provider Demographics
NPI:1205817962
Name:GRAY, SHARON L (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:GRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13022 HENSON CT
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2938
Mailing Address - Country:US
Mailing Address - Phone:703-742-6040
Mailing Address - Fax:
Practice Address - Street 1:525 CARPENTER ROAD
Practice Address - Street 2:
Practice Address - City:FORT MYER
Practice Address - State:VA
Practice Address - Zip Code:22211
Practice Address - Country:US
Practice Address - Phone:703-696-7938
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040054471041C0700X
DCLC30008581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical