Provider Demographics
NPI:1699128835
Name:GREY GROUP LLC
Entity type:Organization
Organization Name:GREY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CHASTEEN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP, LCSW, MAC
Authorized Official - Phone:843-817-9008
Mailing Address - Street 1:704 KINGSMOOR DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-3502
Mailing Address - Country:US
Mailing Address - Phone:843-817-9008
Mailing Address - Fax:
Practice Address - Street 1:958 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2148
Practice Address - Country:US
Practice Address - Phone:864-231-6632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC69261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty