Provider Demographics
NPI:1881287050
Name:GORDON-BRAY, ALANE BETH (BA, QP, CADC)
Entity type:Individual
Prefix:
First Name:ALANE
Middle Name:BETH
Last Name:GORDON-BRAY
Suffix:
Gender:F
Credentials:BA, QP, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27894-0933
Mailing Address - Country:US
Mailing Address - Phone:252-371-1589
Mailing Address - Fax:252-371-1590
Practice Address - Street 1:2506 NASH ST N UNIT B
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1393
Practice Address - Country:US
Practice Address - Phone:252-371-1589
Practice Address - Fax:252-371-1590
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-20884101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)