Provider Demographics
NPI:1679834642
Name:GRAY, ASHLEY N (LCSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
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 1:1718 GEORGETOWN CIR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5552
Mailing Address - Country:US
Mailing Address - Phone:870-219-5369
Mailing Address - Fax:870-972-4911
Practice Address - Street 1:1905 CHATEAU BLVD
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-6279
Practice Address - Country:US
Practice Address - Phone:501-733-9565
Practice Address - Fax:870-215-0772
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker