Provider Demographics
NPI:1588122634
Name:GRAY, VICTORIA JOHNSON (LCSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JOHNSON
Last Name:GRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:JOHNSON
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1104 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-2327
Mailing Address - Country:US
Mailing Address - Phone:260-963-1805
Mailing Address - Fax:
Practice Address - Street 1:1350 US HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-6106
Practice Address - Country:US
Practice Address - Phone:270-365-2008
Practice Address - Fax:270-365-2009
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2561171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical