Provider Demographics
NPI:1780318667
Name:GRAY, JESSICA DANIELLE (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DANIELLE
Last Name:GRAY
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HEADWATER DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3665
Mailing Address - Country:US
Mailing Address - Phone:804-239-0836
Mailing Address - Fax:
Practice Address - Street 1:321 POPLAR DR STE C
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9391
Practice Address - Country:US
Practice Address - Phone:804-733-5591
Practice Address - Fax:804-733-3506
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX673271041C0700X
VA09040136491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical