Provider Demographics
NPI:1750024659
Name:GRAY, ERIK (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-390 KUAHELANI AVE STE 3AC111
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1192
Mailing Address - Country:US
Mailing Address - Phone:808-446-9723
Mailing Address - Fax:
Practice Address - Street 1:1128 ALA NAPUNANI ST APT 509
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-1606
Practice Address - Country:US
Practice Address - Phone:808-446-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical