Provider Demographics
NPI:1952609554
Name:GRAY, RICA MILLER (LPC, NCC, CRC)
Entity Type:Individual
Prefix:MRS
First Name:RICA
Middle Name:MILLER
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPC, NCC, CRC
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 16122
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236-6122
Mailing Address - Country:US
Mailing Address - Phone:601-278-5394
Mailing Address - Fax:601-362-2815
Practice Address - Street 1:4500 I 55 N
Practice Address - Street 2:SUITE 220
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5930
Practice Address - Country:US
Practice Address - Phone:601-278-5394
Practice Address - Fax:601-847-5767
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-05
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional