Healthcare Provider Details

I. General information

NPI: 1710602289
Provider Name (Legal Business Name): MICHAEL E GROSS LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 SIMBURY GLEN CT
CARY NC
27519-8126
US

IV. Provider business mailing address

3901 BARRETT DR STE 100
RALEIGH NC
27609-6523
US

V. Phone/Fax

Practice location:
  • Phone: 770-503-5312
  • Fax:
Mailing address:
  • Phone: 919-900-7552
  • Fax: 919-977-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16853
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: