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Organization
SHADES OF GRAY WELLNESS CENTER
Active
Organization
SHADES OF GRAY WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GENEVA GRAY PHD (COO)
(770) 559-9919
Entity
Organization
Contact information
Practice address
2330 SCENIC HWY S, SUITE 115, SNELLVILLE, GA 30078-3115
(770) 559-9919
(404) 891-5095
Mailing address
2330 SCENIC HWY S, SUITE 115, SNELLVILLE, GA 30078-3115
(770) 559-9919
(404) 891-5095
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC004236
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
922721756B
—
GA
Enumeration date
08/28/2012
Last updated
08/28/2012
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