Provider Demographics
NPI:1922433291
Name:GRAY-DALTON, ANNIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:
Last Name:GRAY-DALTON
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:PO BOX 654
Mailing Address - Street 2:180 MAIN ST
Mailing Address - City:CALHOUN
Mailing Address - State:KY
Mailing Address - Zip Code:42327-0654
Mailing Address - Country:US
Mailing Address - Phone:270-273-3050
Mailing Address - Fax:270-273-3052
Practice Address - Street 1:180 MAIN ST
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:KY
Practice Address - Zip Code:42327
Practice Address - Country:US
Practice Address - Phone:270-273-3050
Practice Address - Fax:270-273-3052
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical