Individual
DR. JAMES RUSSELL GRAY-COUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
348 ENTERPRISE DR STE B, VALDOSTA, GA 31601-5169
(229) 293-0132
Mailing address
348 ENTERPRISE DR STE B, VALDOSTA, GA 31601-5169
(229) 293-0132
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810007761
VA
103TC0700X
Clinical Psychologist
68-019393
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30610026
—
KY
Enumeration date
06/13/2007
Last updated
02/25/2022
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