Provider Demographics
NPI:1013686559
Name:GRAY, CHRISTINA LYN (LMSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LYN
Last Name:GRAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 PALMETTO POINTE RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-6721
Mailing Address - Country:US
Mailing Address - Phone:843-423-4700
Mailing Address - Fax:
Practice Address - Street 1:145 PALMETTO POINTE RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-6721
Practice Address - Country:US
Practice Address - Phone:843-423-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13720104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker