Provider Demographics
NPI:1598823445
Name:GRAY, BOBBIE J (LCSW)
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:J
Last Name:GRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 HARLAN DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-3318
Mailing Address - Country:US
Mailing Address - Phone:530-515-3826
Mailing Address - Fax:
Practice Address - Street 1:448 REDCLIFF DR STE 215
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0169
Practice Address - Country:US
Practice Address - Phone:530-515-3826
Practice Address - Fax:530-222-2854
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 206801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical