Healthcare Provider Details

I. General information

NPI: 1477800514
Provider Name (Legal Business Name): MELISSA GRAY KENNEDY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MELISSA ANNE GRAY

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 E NC HIGHWAY 54 BULIDING 2200
DURHAM NC
27713-5263
US

IV. Provider business mailing address

150 PROVIDENCE RD STE 101
CHAPEL HILL NC
27514-2208
US

V. Phone/Fax

Practice location:
  • Phone: 919-493-0959
  • Fax: 919-493-0970
Mailing address:
  • Phone: 919-914-0072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC009482
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: