Provider Demographics
NPI:1336563527
Name:GRAY, ASHA (LPC)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7982 HIDDEN BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-3206
Mailing Address - Country:US
Mailing Address - Phone:773-531-8390
Mailing Address - Fax:
Practice Address - Street 1:1727 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2700
Practice Address - Country:US
Practice Address - Phone:202-830-3249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14418101YP2500X
VA0701008042101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DR81-0000OtherCAREFIRST