Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 0004236 | GA |
NPI | 1003068529 |
---|---|
Provider Name | Dr. Geneva Marie Gray |
First Address | Snellville, GA 30078-3115 |
Second Address | Snellville, GA 30078-3115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2008 |
Last Update Date | 28/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
922721756B | (05) | GA |