Individual
ANDRE D WRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13320 PIKE LAKE DRIVE, RIVERVIEW, FL 33579-4039
(813) 819-1910
Mailing address
13320 PIKE LAKE DRIVE, RIVERVIEW, FL 33579-4039
(813) 819-1910
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
—
FL
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
03/21/2023
Last updated
03/21/2023
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