Provider Demographics
NPI:1417071523
Name:JARROD L. GRAY, LPC, PC
Entity Type:Organization
Organization Name:JARROD L. GRAY, LPC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:910-381-0347
Mailing Address - Street 1:7736 MARYMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8701
Mailing Address - Country:US
Mailing Address - Phone:910-381-0347
Mailing Address - Fax:910-355-2427
Practice Address - Street 1:824 GUM BRANCH RD
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6269
Practice Address - Country:US
Practice Address - Phone:910-381-0347
Practice Address - Fax:910-355-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty