Provider Demographics
NPI:1265224422
Name:GRAY, SYDNEY (LPCA)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 PETTIGRU ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3112
Mailing Address - Country:US
Mailing Address - Phone:864-741-2102
Mailing Address - Fax:
Practice Address - Street 1:311 PETTIGRU ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3112
Practice Address - Country:US
Practice Address - Phone:864-741-2102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCOU10397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty