MEDICARE: GRACE R STROUD M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2003	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	046HV	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255387973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE R STROUD M.A.

Provider Business Mailing Address
First Line	:	1005 MILLS ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27608-1833
Country	:	US
Telephone Number	:	919-818-3689
Fax Number	:

Provider Business Practice Location Address
First Line	:	3948 BROWNING PL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6512
Country	:	US
Telephone Number	:	919-783-6776
Fax Number	:	919-783-6776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	03/10/2018

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Directions to “ GRACE R STROUD M.A.” Practice Location

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