Provider Demographics
NPI:1548626336
Name:HETHER-GRAY, SHANDELLE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:SHANDELLE
Middle Name:
Last Name:HETHER-GRAY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:SHANDELLE
Other - Middle Name:
Other - Last Name:HETHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHC-LP
Mailing Address - Street 1:2324 W JOPPA RD STE 410
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4620
Mailing Address - Country:US
Mailing Address - Phone:443-446-4718
Mailing Address - Fax:347-391-0191
Practice Address - Street 1:247 PROSPECT AVE STE 4H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-8403
Practice Address - Country:US
Practice Address - Phone:347-509-7127
Practice Address - Fax:347-391-0191
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP00514101YM0800X
NY008136101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health