Provider Demographics
NPI:1720862584
Name:GRAY, ALISSA (MA)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8242 BROOKSTONE LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4474
Mailing Address - Country:US
Mailing Address - Phone:828-505-5366
Mailing Address - Fax:
Practice Address - Street 1:1676 MARYLAND AVE NE APT 470E
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7675
Practice Address - Country:US
Practice Address - Phone:828-505-5366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health