Provider Demographics
NPI:1376889980
Name:THERESE GRAY
Entity Type:Organization
Organization Name:THERESE GRAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LRC
Authorized Official - Phone:973-953-5771
Mailing Address - Street 1:2186 HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5110
Mailing Address - Country:US
Mailing Address - Phone:973-953-5771
Mailing Address - Fax:908-686-3859
Practice Address - Street 1:2186 HALSEY ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5110
Practice Address - Country:US
Practice Address - Phone:973-953-5771
Practice Address - Fax:908-686-3859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00239500251S00000X
NJ37RC00244100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health