Provider Demographics
NPI:1104167113
Name:GRAY, NICOLE MARIE (LPCC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 BETA DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2363
Mailing Address - Country:US
Mailing Address - Phone:440-446-9696
Mailing Address - Fax:440-449-1435
Practice Address - Street 1:7541 MENTOR AVE # A104
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5431
Practice Address - Country:US
Practice Address - Phone:440-968-6341
Practice Address - Fax:440-431-3830
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0004187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional