Doctor Name: | MS. CAROLYN A GRAY |
NPI Number: | 1467483610 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA LADC |
License Number: | LC784 |
Business Practice Address: | 650 Main Street Suite 103 So Portland, ME - 04106 |
Business Phone Number: | 2077744564 |
Business Fax Number: | 2077740006 |
Mailing Address: | 650 Main Street, Suite 103 SO PORTLAND |
State: | ME |
Postal Code: | 04106 |
Phone Number: | 2077744564 |
Fax Number: | 2077740006 |
NPI Enumeration Date: | 07/06/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | LC784 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |