Healthcare Provider Details

I. General information

NPI: 1144750563
Provider Name (Legal Business Name): ESUPPORT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BARRETT DR STE 100
RALEIGH NC
27609-6523
US

IV. Provider business mailing address

3901 BARRETT DR STE 100
RALEIGH NC
27609-6523
US

V. Phone/Fax

Practice location:
  • Phone: 919-900-7552
  • Fax:
Mailing address:
  • Phone: 919-900-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberS7963
License Number StateNC

VIII. Authorized Official

Name: DR. ELIZABETH A GRADY
Title or Position: OWNER
Credential: LCMHCS
Phone: 919-900-7552