Provider Demographics
NPI:1215502778
Name:HOUSE OF GRAY, PLLC
Entity type:Organization
Organization Name:HOUSE OF GRAY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KALITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-987-8850
Mailing Address - Street 1:26 WOODS CT
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-5471
Mailing Address - Country:US
Mailing Address - Phone:910-987-8850
Mailing Address - Fax:
Practice Address - Street 1:7404 CHAPEL HILL RD STE B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5043
Practice Address - Country:US
Practice Address - Phone:919-355-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty