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General NPI Number Information
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NPI Number | 1760602007
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Entity Type | Individual
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Provider Name | ALICIA MARIE GREGORY LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 111 DOLLY ST
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City | GRAY
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State | GA
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Zip | 31032-5307
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Country | US
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Telephone | 478-491-1991
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Fax | 478-986-2337
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Provider Business Mailing Address
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Address Line | 276 KATHERINE DR
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City | GRAY
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State | GA
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Zip | 31032-3865
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Country | US
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Telephone | 478-491-1991
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Fax | 478-986-2337
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT001039
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License Number State | GA
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