Provider Demographics
NPI:1104938000
Name:GRAY, ELLEN B (PHD LCSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:B
Last Name:GRAY
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 HILLANDALE RD STE 1B-274
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2659
Mailing Address - Country:US
Mailing Address - Phone:919-391-4313
Mailing Address - Fax:949-577-4695
Practice Address - Street 1:1821 HILLANDALE RD STE 1B-274
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2659
Practice Address - Country:US
Practice Address - Phone:919-391-4313
Practice Address - Fax:949-577-4695
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0034091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical