Provider Demographics
NPI:1881248250
Name:GRAY, ATHENA D (LMHC)
Entity type:Individual
Prefix:MS
First Name:ATHENA
Middle Name:D
Last Name:GRAY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84-5210 PAINTED CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CAPTAIN COOK
Mailing Address - State:HI
Mailing Address - Zip Code:96704-8410
Mailing Address - Country:US
Mailing Address - Phone:808-640-4447
Mailing Address - Fax:
Practice Address - Street 1:84-5210 PAINTED CHURCH RD
Practice Address - Street 2:
Practice Address - City:CAPTAIN COOK
Practice Address - State:HI
Practice Address - Zip Code:96704-8410
Practice Address - Country:US
Practice Address - Phone:808-640-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI585OtherMENTAL HEALTH COUNSELOR STATE LICENSE NUMBER