| Doctor Name: | STACEY GRAY |
| NPI Number: | 1659673572 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW-C |
| License Number: | 15278 |
| Business Practice Address: | 21770 Fdr Blvd Lexington Park, MD - 206531558 |
| Business Phone Number: | 3018636661 |
| Business Fax Number: | 3018669189 |
| Mailing Address: | 30007 Business Center Dr, CHARLOTTE HALL |
| State: | MD |
| Postal Code: | 206223101 |
| Phone Number: | 3019971300 |
| Fax Number: | 3018669189 |
| NPI Enumeration Date: | 11/29/2010 |
| NPI Last Update Date: | 11/29/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 15278 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |