Provider Demographics
NPI:1578956272
Name:GRAY, TONYA MICHELLE (MSW, LCSW-A, LCAS-A)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:MICHELLE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSW, LCSW-A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-0728
Mailing Address - Country:US
Mailing Address - Phone:910-893-7233
Mailing Address - Fax:910-893-3508
Practice Address - Street 1:1210 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-7924
Practice Address - Country:US
Practice Address - Phone:910-893-7233
Practice Address - Fax:910-893-3508
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-20375101YA0400X
NCP0086251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)