Provider Demographics
NPI:1427704949
Name:GRAY, BRANDI ALANE (LPC)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:ALANE
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 1:927 WELTON AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-2518
Mailing Address - Country:US
Mailing Address - Phone:405-798-7455
Mailing Address - Fax:
Practice Address - Street 1:400 ROANOKE ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3139
Practice Address - Country:US
Practice Address - Phone:540-381-6215
Practice Address - Fax:540-381-6216
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty