Provider Demographics
NPI:1568038842
Name:GRAY, REBECCA ALICE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ALICE
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 CHARLES CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-7704
Mailing Address - Country:US
Mailing Address - Phone:205-907-4675
Mailing Address - Fax:
Practice Address - Street 1:3440 MARTIN ST S STE 8
Practice Address - Street 2:
Practice Address - City:CROPWELL
Practice Address - State:AL
Practice Address - Zip Code:35054-3850
Practice Address - Country:US
Practice Address - Phone:888-355-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health