Healthcare Provider Details

I. General information

NPI: 1497070452
Provider Name (Legal Business Name): WILLIAM HENRY GREGORY JR. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WIILIAM HENRY GREGORY JR. PH.D.

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9985 VILLAGE GREEN DRIVE
WOODSTOCK MD
21163
US

IV. Provider business mailing address

9985 VILLAGE GREEN DRIVE
WOODSTOCK MD
21163
US

V. Phone/Fax

Practice location:
  • Phone: 410-521-5818
  • Fax: 443-272-7560
Mailing address:
  • Phone: 410-521-5818
  • Fax: 443-272-7560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC5741
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number391
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: