Provider Demographics
NPI:1780953059
Name:GRAY, STEPHANIE L
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:L
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAFAYETTE PLAISANCE ST APT 2110
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2870
Mailing Address - Country:US
Mailing Address - Phone:313-348-5459
Mailing Address - Fax:
Practice Address - Street 1:2888 W GRAND BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2612
Practice Address - Country:US
Practice Address - Phone:313-874-8702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)