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General NPI Number Information
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NPI Number | 1891429155
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Entity Type | Individual
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Provider Name | GREGORY CONNUCK
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Gender | Male
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 501 EASTOWNE DR STE 220
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City | CHAPEL HILL
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State | NC
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Zip | 27514-6224
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Country | US
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Telephone | 919-408-3212
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Fax |
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Provider Business Mailing Address
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Address Line | 98 LOUISIANA AVE
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City | ASHEVILLE
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State | NC
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Zip | 28806-3448
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Country | US
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Telephone | 212-300-7362
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P017813
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License Number State | NC
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