Provider Demographics
NPI:1205992039
Name:GRAY, THERESE EMELDA (LPC, LRC)
Entity type:Individual
Prefix:MS
First Name:THERESE
Middle Name:EMELDA
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPC, LRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5110
Mailing Address - Country:US
Mailing Address - Phone:973-953-5771
Mailing Address - Fax:908-810-0118
Practice Address - Street 1:2143 MORRIS AVE
Practice Address - Street 2:SUITE 4A
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6036
Practice Address - Country:US
Practice Address - Phone:973-953-5771
Practice Address - Fax:908-810-0118
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37RC002441000101YM0800X
NJ37PC00239500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional