Provider Demographics
NPI:1932876000
Name:GRAY, PAMELA CARYL (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:CARYL
Last Name:GRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4196 HIGHWAY 62 412 STE A
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-8002
Mailing Address - Country:US
Mailing Address - Phone:870-856-1202
Mailing Address - Fax:870-856-2107
Practice Address - Street 1:116 CONCORD RD STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2941
Practice Address - Country:US
Practice Address - Phone:870-856-1202
Practice Address - Fax:870-856-2107
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN76441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty