Provider Demographics
NPI:1457008880
Name:BASS, ALEXANDER GREY (NCC, MHC-LP, LCMHCA)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GREY
Last Name:BASS
Suffix:
Gender:M
Credentials:NCC, MHC-LP, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 CRANBERRY RIDGE DR SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-9708
Mailing Address - Country:US
Mailing Address - Phone:252-382-3103
Mailing Address - Fax:
Practice Address - Street 1:127 GOLDSBORO ST S
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4903
Practice Address - Country:US
Practice Address - Phone:252-360-4873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-06
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112626-01101YM0800X
NCA17386101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health