Provider Demographics
NPI:1972715092
Name:GRAY, TONYA (MSW, CAC-II)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSW, CAC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 CARTWRIGHT LANE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178
Mailing Address - Country:US
Mailing Address - Phone:734-451-7800
Mailing Address - Fax:734-451-5410
Practice Address - Street 1:575 S. MAIN STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170
Practice Address - Country:US
Practice Address - Phone:734-451-7800
Practice Address - Fax:734-451-5410
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802066320101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)