Active NPI
Marshall Guilbert Gravely, LCSW
- Clinical Social Worker
- Lexington, NC
National Provider Identifier
1235247628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C002471
- Practice address
- 420 N Salisbury St
Lexington, NC 27292-3548 - Phone
- (336) 243-7475
- Fax
- (336) 249-6771
- NPI assigned
- Aug 27, 2006
- Last updated
- Oct 21, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C002471 | NC | Primary |
Addresses
Primary practice location
420 N Salisbury St
Lexington, NC 27292-3548
Mailing address
200 E 2ND Ave
Gastonia, NC 28052-4358
Phone (704) 874-1904
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 191052 | Other | NC | MEDCOST |
| 2327208 | Other | NC | CIGNA |
| 6003651 | Medicaid | NC | |
| 1235247628 | Other | NC | TRICARE |
| 1235247628 | Other | NC | CORPHEALTH |
| 1235247628 | Other | NC | UNITED BEHAVIORAL HEALTH |
| 132MR | Other | NC | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C002471 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571616000000",
"number": "1235247628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 E 2ND AVE",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280524358",
"telephone_number": "704-874-1904",
"fax_number": "704-867-2134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 N SALISBURY ST",
"city": "LEXINGTON",
"state": "NC",
"postal_code": "272923548",
"telephone_number": "336-243-7475",
"fax_number": "336-249-6771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAVELY",
"first_name": "MARSHALL",
"middle_name": "GUILBERT",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-27",
"last_updated": "2019-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C002471",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "191052",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "2327208",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6003651",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "1235247628",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CORPHEALTH",
"identifier": "1235247628",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "1235247628",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "132MR",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lexington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.