Provider Demographics
NPI:1841682051
Name:GRAY, KRISTI DAWN (CADC)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:DAWN
Last Name:GRAY
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:896 S HIGHWAY 25 W
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-1691
Mailing Address - Country:US
Mailing Address - Phone:606-515-6124
Mailing Address - Fax:606-515-6163
Practice Address - Street 1:896 S HIGHWAY 25 W
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1691
Practice Address - Country:US
Practice Address - Phone:606-515-6124
Practice Address - Fax:606-515-6163
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1158101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)