Provider Demographics
NPI:1437993201
Name:GRAY, ERICA LIZETH (LCSW)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LIZETH
Last Name:GRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LIZETH
Other - Last Name:ORELLANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 COTTON GIN LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-8129
Mailing Address - Country:US
Mailing Address - Phone:770-369-2875
Mailing Address - Fax:
Practice Address - Street 1:24112 A ST
Practice Address - Street 2:
Practice Address - City:BEALE AFB
Practice Address - State:CA
Practice Address - Zip Code:95903-1713
Practice Address - Country:US
Practice Address - Phone:530-634-2953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2024-03991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical