Provider Demographics
NPI:1396844239
Name:GREGORY, ROBERT D (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:GREGORY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2401 WOOTEN BLVD SW
Mailing Address - Street 2:SUITE K
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4464
Mailing Address - Country:US
Mailing Address - Phone:252-291-0735
Mailing Address - Fax:252-291-2890
Practice Address - Street 1:2401 WOOTEN BLVD SW
Practice Address - Street 2:SUITE K
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4464
Practice Address - Country:US
Practice Address - Phone:252-291-0735
Practice Address - Fax:252-291-2890
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC617103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000006Medicaid
NC03647OtherBC/BS OF NC AS PSYCHOLOGI
NC6000006Medicaid