Provider Demographics
NPI:1033639067
Name:GREGORY, DEDRA ARMSTRONG (MS, LPCA, CRC)
Entity Type:Individual
Prefix:MRS
First Name:DEDRA
Middle Name:ARMSTRONG
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MS, LPCA, CRC
Other - Prefix:MS
Other - First Name:DEDRA
Other - Middle Name:CIARA
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 QUINN CT
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 QUINN CT
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8021
Practice Address - Country:US
Practice Address - Phone:252-312-7144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10936101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health