Provider Demographics
NPI:1386348365
Name:GREGORY, MEREDITH YATES (BS-ITFS)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:YATES
Last Name:GREGORY
Suffix:
Gender:F
Credentials:BS-ITFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 MASSEY RD
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-9096
Mailing Address - Country:US
Mailing Address - Phone:336-932-1712
Mailing Address - Fax:
Practice Address - Street 1:642 MASSEY RD
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-9096
Practice Address - Country:US
Practice Address - Phone:336-932-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health