Individual
MISTY JEAN GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
SAC
Contact information
Practice address
1717 TAYLOR AVE, RACINE, WI 53403-2405
(262) 638-6407
Mailing address
1717 TAYLOR AVE, RACINE, WI 53403-2405
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17116-131
WI
Other
Enumeration date
03/02/2022
Last updated
08/01/2024
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