Individual
MS. MARLISE V. GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED., LPC, NCC
Contact information
Practice address
2013 DEVONSHIRE DR. SUITE 115, COLUMBUS, GA 31904
(706) 576-6575
(706) 507-0590
Mailing address
2013 DEVONSHIRE DR. SUITE 115, COLUMBUS, GA 31904
(706) 576-6575
(706) 507-0590
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC003796
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208008890
NON-MEDICARE
GA
Enumeration date
07/19/2018
Last updated
07/19/2018
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