Healthcare Provider Details

I. General information

NPI: 1821105024
Provider Name (Legal Business Name): ARRAN Y GREGG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 EVANS ST SUITE A
GREENVILLE NC
27834-4534
US

IV. Provider business mailing address

3491 EVANS ST SUITE A
GREENVILLE NC
27834-4534
US

V. Phone/Fax

Practice location:
  • Phone: 252-341-0078
  • Fax: 252-321-7840
Mailing address:
  • Phone: 252-341-0078
  • Fax: 252-321-7840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004217
License Number StateNC

VIII. Authorized Official

Name: ARRAN Y. GREGG
Title or Position: MEMBER AND ORGANIZER
Credential: LCSW
Phone: 252-341-0078