Individual
EMPRESS ANDREA GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2048 N 34TH ST, MILWAUKEE, WI 53208-1967
(414) 400-1526
Mailing address
2048 N 34TH ST, MILWAUKEE, WI 53208-1967
(414) 400-1526
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17180-130
WI
Other
Enumeration date
07/12/2014
Last updated
07/12/2014
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