Provider Demographics
NPI:1437306222
Name:GRAY, GLORI GRUBBS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GLORI
Middle Name:GRUBBS
Last Name:GRAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 VAIL AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1527
Mailing Address - Country:US
Mailing Address - Phone:503-547-5769
Mailing Address - Fax:704-765-4749
Practice Address - Street 1:1816 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2416
Practice Address - Country:US
Practice Address - Phone:704-313-9071
Practice Address - Fax:704-765-4749
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2482103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist