Provider Demographics
NPI:1902975980
Name:GRAY, VENUS ROSE (RADI)
Entity Type:Individual
Prefix:MS
First Name:VENUS
Middle Name:ROSE
Last Name:GRAY
Suffix:
Gender:F
Credentials:RADI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 AUBURN BLVD # 2200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4167
Mailing Address - Country:US
Mailing Address - Phone:916-473-5764
Mailing Address - Fax:916-473-5766
Practice Address - Street 1:4330 AUBURN BLVD # 2200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4167
Practice Address - Country:US
Practice Address - Phone:916-473-5764
Practice Address - Fax:916-473-5766
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)