Provider Demographics
NPI:1770517864
Name:WRAY, GLORIA PAGE (LPC)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:PAGE
Last Name:WRAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 TELLOWEE RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-9542
Mailing Address - Country:US
Mailing Address - Phone:336-623-8334
Mailing Address - Fax:336-627-1785
Practice Address - Street 1:439 W KINGS HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5013
Practice Address - Country:US
Practice Address - Phone:336-623-1800
Practice Address - Fax:336-627-1785
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102062Medicaid
NC1180WOtherBCBSNC