Provider Demographics
NPI:1952184541
Name:GRAY, STACI MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:MARIE
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 1:165 VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:AL
Mailing Address - Zip Code:35096
Mailing Address - Country:US
Mailing Address - Phone:229-309-0425
Mailing Address - Fax:
Practice Address - Street 1:165 VALLEY CIR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:AL
Practice Address - Zip Code:35096
Practice Address - Country:US
Practice Address - Phone:229-309-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0086901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical