Shades of Gray Wellness Center

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC004236 Issued in GA

Legal business name

SHADES OF GRAY WELLNESS CENTER

Practice address

2330 Scenic Hwy S
Suite 115
Snellville, GA 30078-3115

Phone

(770) 559-9919

Fax

(404) 891-5095

NPI assigned

Aug 28, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Geneva Gray, PHDNPI 1003068529

Title

Coo

Phone

(770) 559-9919

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Geneva Marie Gray, PHD, LPC, NCC, CPCS

  • Counselor
  • Snellville, GA
  • NPI 1003068529
  NPD (past) Authorized official
• Pamela K. Merritt, LCSW

  • Clinical Social Worker
  • Snellville, GA
  • NPI 1104214188
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346112000000",
    "number": "1235487919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 SCENIC HWY S",
            "address_2": "SUITE 115",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300783115",
            "telephone_number": "770-559-9919",
            "fax_number": "404-891-5095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 SCENIC HWY S",
            "address_2": "SUITE 115",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300783115",
            "telephone_number": "770-559-9919",
            "fax_number": "404-891-5095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADES OF GRAY WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-28",
        "last_updated": "2012-08-28",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "GENEVA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "770-559-9919",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC004236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "922721756B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Serenity Bridge Telepsychiatry & Weight Management, LLC
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• Serenity Palliative and Hospice Care of Hillendale, Inc.
• Serving at-Risk Families Everywhere
• Kaylee Radford Sexton, PA-C
• Trupti Shah
• Sonya Dubose Shaheed, FNP-C
• Mohamad Saeed S Shahidsalles, M.D., PH.D.
• Vaseem Shaikh
• Moshe Shapiro, MD

• Professional Counselor in Snellville, GA
• Providers in Snellville, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.