Kellisha Gray, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C011140 Issued in NC

Practice address

731 Tilghman Dr
Dunn, NC 28334-5507

Phone

(910) 249-4219

NPI assigned

Sep 2, 2015

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: kellishagray@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mental Health Specialty Group PA

  dba Rula Health

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634
  Medicare reassignment NPD
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Clinical

  NPD

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

{
    "created_epoch": "1441152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1992173355",
    "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": "910-814-4015",
            "fax_number": "910-814-4015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 TILGHMAN DR",
            "city": "DUNN",
            "state": "NC",
            "postal_code": "283345507",
            "telephone_number": "910-249-4219"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Bella Howington Dr",
            "address_purpose": "LOCATION",
            "city": "Lillington",
            "state": "NC",
            "postal_code": "275465666",
            "country_code": "US",
            "telephone_number": "910-814-4015",
            "fax_number": "910-814-4015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAY",
        "first_name": "KELLISHA",
        "name_prefix": "Mrs.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-02",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C011140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992173355",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sri Anjali Gorle
• Goshen Medical Center Incorporated (GMC Pharmacy at Dunn)
• Goshen Medical Center, Inc (Goshen Medical Center - Dunn)
• Kathryn Gower
• Richard Martin Graveen, ATC
• Patrick Hampton Gray, MD
• Greater Pathways, LLC
• Samuel Thorne Gregory Jr., DDS
• Nathalie Julienne Grippon, PA-C
• H & H Health Care Services, LLC

• Clinical Social Worker in Dunn, NC
• Providers in Dunn, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.