Provider Demographics
NPI:1124052055
Name:GRAY-TERRY, NANCY (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GRAY-TERRY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SANDI
Other - Middle Name:
Other - Last Name:GRAY-TERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:ORIENTAL
Mailing Address - State:NC
Mailing Address - Zip Code:28571-0344
Mailing Address - Country:US
Mailing Address - Phone:252-431-0075
Mailing Address - Fax:
Practice Address - Street 1:221 ORANGE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4234
Practice Address - Country:US
Practice Address - Phone:252-431-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0025341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC36593OtherBC/BS PROVIDER #
NC6002025Medicaid
NC6003804Medicaid
NC56-2128417OtherFED. TID: CRESCENT MOON