| NPI | 1427559772 |
|---|---|
| Former Name | THERESA ANN GRAY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0217621) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM T-0193191) |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2021-07-21 |