Provider Demographics
NPI:1699445882
Name:HARRISON-GRAY, ELIZABETH GENINE (RBT, BS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GENINE
Last Name:HARRISON-GRAY
Suffix:
Gender:F
Credentials:RBT, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 COUNTY ROAD 52
Mailing Address - Street 2:
Mailing Address - City:ARITON
Mailing Address - State:AL
Mailing Address - Zip Code:36311-5301
Mailing Address - Country:US
Mailing Address - Phone:334-379-5329
Mailing Address - Fax:
Practice Address - Street 1:1880 S UNION AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-2898
Practice Address - Country:US
Practice Address - Phone:334-443-1043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician