NPIMap

Organization Active NPI

Carolina Psychology Group, PLLC

  • Clinical Psychologist
  • Winston Salem, NC
National Provider Identifier
1265997407
Registry record updated Apr 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
CAROLINA PSYCHOLOGY GROUP, PLLC
Practice address
100 S Marshall St Ste 1
Winston Salem, NC 27101-2843
Phone
(336) 276-1278
Fax
(336) 276-1516
NPI assigned
Feb 1, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2022

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

Authorized official

Name
Dr. Samuel Bemiss Gray, PSYDNPI 1467407908
Title
Owner
Phone
(336) 276-1278

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

100 S Marshall St Ste 1
Winston Salem, NC 27101-2843

Mailing address

100 S Marshall St Ste 1
Winston Salem, NC 27101-2843
Phone (336) 276-1278

Other practice location 1

2910 Briarcliffe Rd Ste A
Winston Salem, NC 27106-3177
Phone (336) 276-1278 ext. 200

National Provider Directory

National Provider Directory

Locations

100 S Marshall St
Ste 1
Winston Salem, NC 27101
Phone (336) 276-1278

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1548979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649030400000",
    "number": "1265997407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S MARSHALL ST STE 1",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271012843",
            "telephone_number": "336-276-1278",
            "fax_number": "336-276-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S MARSHALL ST STE 1",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271012843",
            "telephone_number": "336-276-1278",
            "fax_number": "336-276-1516"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2910 Briarcliffe Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271063177",
            "country_code": "US",
            "telephone_number": "336-276-1278 x200",
            "fax_number": "336-276-1516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CAROLINA PSYCHOLOGY GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-01",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "BEMISS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-276-1278",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 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.