Healthcare Provider Details

I. General information

NPI: 1619386653
Provider Name (Legal Business Name): GRETTA HEYWARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 PAISLEY AVE
FAYETTEVILLE NC
28304
US

IV. Provider business mailing address

PO BOX 901
PARKTON NC
28371-0901
US

V. Phone/Fax

Practice location:
  • Phone: 910-813-9529
  • Fax:
Mailing address:
  • Phone: 910-813-9529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20523
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC010231
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: