Provider Demographics
NPI:1487747531
Name:PERKINS, GREGORY EUGENE (LCASA, LAPSW)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EUGENE
Last Name:PERKINS
Suffix:
Gender:M
Credentials:LCASA, LAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 RIVERCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3372
Mailing Address - Country:US
Mailing Address - Phone:910-797-4844
Mailing Address - Fax:
Practice Address - Street 1:2744 RIVERCLIFF ROAD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3372
Practice Address - Country:US
Practice Address - Phone:910-630-6994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN91101Y00000X, 101YP1600X, 171M00000X
NC24279101YM0800X, 101YA0400X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator