Provider Demographics
NPI:1720310295
Name:GRAY, LUISA HELENA (MA, ATR-BC, LPC)
Entity type:Individual
Prefix:
First Name:LUISA
Middle Name:HELENA
Last Name:GRAY
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 OLD ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-4511
Mailing Address - Country:US
Mailing Address - Phone:215-887-1084
Mailing Address - Fax:
Practice Address - Street 1:678 PONT READING RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1917
Practice Address - Country:US
Practice Address - Phone:610-649-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003440101YM0800X
PA02182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health