Active NPI
Kelly Wood Grey, NCC, LPC, LCAS
- Mental Health Counselor
- Concord, NC
National Provider Identifier
1720280605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 4505
- Practice address
- 220 George W Liles Pkwy NW
Concord, NC 28027-6531 - Phone
- (980) 622-7399
- NPI assigned
- Jun 4, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 882 | NC | |
| Mental Health Counselor | 101YM0800X | 4505 | NC | Primary |
Addresses
Primary practice location
220 George W Liles Pkwy NW
Concord, NC 28027-6531
Mailing address
220 George W Liles Pkwy NW
Concord, NC 28027-6531
Phone (980) 622-7399
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 882 | NC | MD | Marriage & Family Therapist |
| 4505 | NC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282780800000",
"number": "1720280605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 GEORGE W LILES PKWY NW",
"city": "CONCORD",
"state": "NC",
"postal_code": "280276531",
"telephone_number": "980-622-7399"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 GEORGE W LILES PKWY NW",
"city": "CONCORD",
"state": "NC",
"postal_code": "280276531",
"telephone_number": "980-622-7399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREY",
"first_name": "KELLY",
"middle_name": "WOOD",
"name_prefix": "Mrs.",
"credential": "NCC, LPC, LCAS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-04",
"last_updated": "2010-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "882",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "4505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.