Healthcare Provider Details

I. General information

NPI: 1609708387
Provider Name (Legal Business Name): ALBONY GRAYS LCMHC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SUNRISE AVE STE 21
LEXINGTON NC
27292-4309
US

IV. Provider business mailing address

210 S MAIN ST APT 323
KANNAPOLIS NC
28081-3223
US

V. Phone/Fax

Practice location:
  • Phone: 704-858-6728
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22610
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: