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Individual

SARA GRAY

Active
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Individual

SARA GRAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LSW

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.923222
OH
101YM0800X
Mental Health Counselor
S.0010199
OH
104100000X
Social Worker
Primary
S.0010199
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0074861
MEDICAID- ODADAS
OH
01
—
0074946
MEDICAID- ODMH
OH
01
—
01-0693
CARF CERTIFICATION
OH
01
—
H130910
MEDICARE GROUP PTAN
OH
Enumeration date
01/31/2017
Last updated
02/08/2017
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