Laquisha Gravely

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A18128 Issued in NC

Practice address

902 S Reilly Rd
Fayetteville, NC 28314-1825

Phone

(910) 491-6356

Fax

(910) 491-8128

NPI assigned

Mar 23, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1104402650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E 6TH AVE",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283762233",
            "telephone_number": "803-446-6661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 S REILLY RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283141825",
            "telephone_number": "910-491-6356",
            "fax_number": "910-491-8128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVELY",
        "first_name": "LAQUISHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-23",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A18128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Larry Grant, R.EEG T.
• Dorrette Patrice Grant, MD
• Renee Grant
• Ursula Grant, PSY.D
• Nicole Grates, PT, DPT
• Regetta Penelope Graves-Dandridge, LPN
• Archita Lavonda Graves, LCSW
• Christopher Graves
• Anissa Gray
• Audrey Gray

• Mental Health Counselor in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.