Provider Demographics
NPI:1124212188
Name:GREGORY-MITCHELL, CHARLOTTE (CBRS TEACHER)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:GREGORY-MITCHELL
Suffix:
Gender:F
Credentials:CBRS TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 PLANTATION PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8262
Mailing Address - Country:US
Mailing Address - Phone:919-738-7682
Mailing Address - Fax:
Practice Address - Street 1:402 PLANTATION PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-8262
Practice Address - Country:US
Practice Address - Phone:919-738-7682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300160Medicaid