Provider Demographics
NPI:1841777513
Name:GRAY, AMY MARIE (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5306 OLD ROUTE 77
Mailing Address - Street 2:
Mailing Address - City:SPARTANSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16434-5532
Mailing Address - Country:US
Mailing Address - Phone:814-663-1438
Mailing Address - Fax:
Practice Address - Street 1:5306 OLD ROUTE 77
Practice Address - Street 2:
Practice Address - City:SPARTANSBURG
Practice Address - State:PA
Practice Address - Zip Code:16434-5532
Practice Address - Country:US
Practice Address - Phone:814-663-1438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPC015640101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health