Healthcare Provider Details

I. General information

NPI: 1487729760
Provider Name (Legal Business Name): JACOB F GREGSON LMFTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 MERRIMON AVE STE 1OFFICEA
ASHEVILLE NC
28801-2360
US

IV. Provider business mailing address

28 BUCK RIDGE RD
FAIRVIEW NC
28730-7602
US

V. Phone/Fax

Practice location:
  • Phone: 501-288-2733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA0606008
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA0606008
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberA0606008
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberA0606008
License Number StateAR
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number12272A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: