Healthcare Provider Details

I. General information

NPI: 1043127590
Provider Name (Legal Business Name): GRAYSON OWEN CURTIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 S KERR AVE STE 200
WILMINGTON NC
28403-4248
US

IV. Provider business mailing address

3612 BEVERLY COVE WAY APT 106
WILMINGTON NC
28412
US

V. Phone/Fax

Practice location:
  • Phone: 910-788-2375
  • Fax:
Mailing address:
  • Phone: 910-788-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number21210A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: