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General NPI Number Information
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NPI Number | 1417071523
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Entity Type | Organization
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Legal Business Name | JARROD L. GRAY, LPC, PC
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 824 GUM BRANCH RD SUITE B
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City | JACKSONVILLE
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State | NC
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Zip | 28540-6269
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Country | US
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Telephone | 910-381-0347
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Fax | 910-355-2427
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Provider Business Mailing Address
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Address Line | 7736 MARYMOUNT DR
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City | WILMINGTON
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State | NC
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Zip | 28411-8701
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Country | US
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Telephone | 910-381-0347
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Fax | 910-355-2427
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR CEO
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Name | MR. JARROD LAWRENCE GRAY
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Credential | LPC., NCC.
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Telephone | 910-381-0347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4576
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License Number State | NC
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