Provider Demographics
NPI:1811168644
Name:GRAY, DIANNE SMITH (LCSW)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:SMITH
Last Name:GRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DIANNE
Other - Middle Name:GEORGENE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:230 2ND ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3275
Mailing Address - Country:US
Mailing Address - Phone:760-942-1815
Mailing Address - Fax:760-942-1815
Practice Address - Street 1:230 2ND ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3275
Practice Address - Country:US
Practice Address - Phone:760-942-1815
Practice Address - Fax:760-942-1815
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS143421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical