Provider Demographics
NPI:1427868504
Name:GREGORY, CASSANDRA S (DR OF EDUCATION)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:S
Last Name:GREGORY
Suffix:
Gender:F
Credentials:DR OF EDUCATION
Other - Prefix:DR
Other - First Name:CASSANDRA
Other - Middle Name:S
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CASSANDRA GREGORY
Mailing Address - Street 1:8800 SHADY PINE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-7116
Mailing Address - Country:US
Mailing Address - Phone:704-287-1935
Mailing Address - Fax:
Practice Address - Street 1:2001 CATHERINE SIMMONS AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-4677
Practice Address - Country:US
Practice Address - Phone:704-492-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC736559405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional