Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | A10494 | NC |
N | 101YS0200X | School Counselor | 1167989 | NC |
NPI | 1083156582 |
---|---|
Provider Name | Crystal Gray I |
First Address | Charlotte, NC 28262-8797 |
Second Address | Charlotte, NC 28262-8797 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2016 |
Last Update Date | 15/11/2016 |