Provider Demographics
NPI:1891865317
Name:GRAY, MONIQUE F (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:F
Last Name:GRAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 MAIN ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3096
Mailing Address - Country:US
Mailing Address - Phone:770-413-1980
Mailing Address - Fax:770-413-8118
Practice Address - Street 1:913 MAIN ST
Practice Address - Street 2:SUITE H
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3096
Practice Address - Country:US
Practice Address - Phone:770-413-1980
Practice Address - Fax:770-413-8118
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002373103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist