| NPI | 1467725085 |
|---|---|
| Former Name | BERNETTA GRAY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA LAC 817) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA CCGC 1005) |
| Enumeration Date | 2012-02-13 |
| Last Update Date | 2019-01-14 |