Healthcare Provider Details

I. General information

NPI: 1235220567
Provider Name (Legal Business Name): GREGORY PHILIP WINSTED M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1473 BIG LEAF LOOP
APEX NC
27502-9018
US

IV. Provider business mailing address

1473 BIG LEAF LOOP
APEX NC
27502-9018
US

V. Phone/Fax

Practice location:
  • Phone: 919-363-7437
  • Fax:
Mailing address:
  • Phone: 919-363-7437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number942
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6105042
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: