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General NPI Number Information
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NPI Number | 1215502778
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Entity Type | Organization
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Legal Business Name | HOUSE OF GRAY, PLLC
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 7404 CHAPEL HILL RD STE B
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City | RALEIGH
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State | NC
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Zip | 27607-5043
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Country | US
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Telephone | 919-355-9050
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Fax |
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Provider Business Mailing Address
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Address Line | 26 WOODS CT
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City | RIDGELAND
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State | SC
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Zip | 29936-5471
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Country | US
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Telephone | 910-987-8850
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | KALITA MCBRIDE
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Credential | LCSW
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Telephone | 910-987-8850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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