Mahogany Place PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MAHOGANY PLACE PLLC

Practice address

125 Bella Howington Dr
Lillington, NC 27546-5666

Phone

(910) 808-1881

NPI assigned

Sep 27, 2019

Organization subpart

No

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

Authorized official

Name

Mrs. Kellisha Gray, MSW, LCSW

Title

Organizer/Member

Phone

(910) 808-1881

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1569542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569542400000",
    "number": "1740831981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 BELLA HOWINGTON DR",
            "city": "LILLINGTON",
            "state": "NC",
            "postal_code": "275465666",
            "telephone_number": "910-808-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 BELLA HOWINGTON DR",
            "city": "LILLINGTON",
            "state": "NC",
            "postal_code": "275465666",
            "telephone_number": "910-808-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAHOGANY PLACE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-27",
        "last_updated": "2019-09-27",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "KELLISHA",
        "authorized_official_title_or_position": "ORGANIZER/MEMBER",
        "authorized_official_telephone_number": "910-808-1881",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Lillington, NC
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• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.

Verify at the official NPI Registry.