Provider Demographics
NPI:1881816973
Name:GRAY, CHRISTOPHER EUGENE (EDS,LPC,NBCC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:EUGENE
Last Name:GRAY
Suffix:
Gender:M
Credentials:EDS,LPC,NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2537 QUEENS CT
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-4519
Mailing Address - Country:US
Mailing Address - Phone:706-863-1088
Mailing Address - Fax:
Practice Address - Street 1:2537 QUEENS CT
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-4519
Practice Address - Country:US
Practice Address - Phone:706-863-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002214101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC002214OtherPROFESSIONAL COUNSELOR