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General NPI Number Information
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NPI Number | 1235011602
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Entity Type | Individual
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Provider Name | LORI GWEN PEGRAM LCMHC
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Gender | Female
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 614 MORGAN COUNTRY RD
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City | ASHEBORO
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State | NC
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Zip | 27203-8342
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Country | US
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Telephone | 336-629-9589
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Fax |
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Provider Business Mailing Address
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Address Line | 515 SPRING GARDEN ST UNIT G
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City | GREENSBORO
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State | NC
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Zip | 27401-2746
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Country | US
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Telephone | 336-251-8760
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A21766
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License Number State | NC
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