Provider Demographics
NPI:1700321544
Name:GRAY, BARBARA
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:GAIL
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7820 BAYMEADOWS RD E
Mailing Address - Street 2:APT 1211
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4637
Mailing Address - Country:US
Mailing Address - Phone:904-800-2233
Mailing Address - Fax:904-800-2231
Practice Address - Street 1:7820 BAYMEADOWS RD E
Practice Address - Street 2:APT 1211
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4637
Practice Address - Country:US
Practice Address - Phone:904-800-2233
Practice Address - Fax:904-800-2231
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)