Provider Demographics
NPI:1538535224
Name:GRAY, HAFIA (MA, LPCC, LADC)
Entity type:Individual
Prefix:
First Name:HAFIA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MA, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 4TH ST E STE 803
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1687
Mailing Address - Country:US
Mailing Address - Phone:651-336-7018
Mailing Address - Fax:
Practice Address - Street 1:275 4TH ST E STE 803
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1687
Practice Address - Country:US
Practice Address - Phone:651-336-7018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304260101YA0400X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)