Provider Demographics
NPI:1831669217
Name:GREY, SEMI (LMHCA, SUDP)
Entity Type:Individual
Prefix:
First Name:SEMI
Middle Name:
Last Name:GREY
Suffix:
Gender:F
Credentials:LMHCA, SUDP
Other - Prefix:
Other - First Name:SEMI
Other - Middle Name:
Other - Last Name:GREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHCA, SUDP
Mailing Address - Street 1:2001 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2673
Mailing Address - Country:US
Mailing Address - Phone:360-448-1807
Mailing Address - Fax:
Practice Address - Street 1:2001 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2673
Practice Address - Country:US
Practice Address - Phone:360-209-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61381857101YA0400X
WAMC61356238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669411377OtherNPN