Provider Demographics
NPI:1497070452
Name:GREGORY, WILLIAM HENRY JR (PHD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
Last Name:GREGORY
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:MR
Other - First Name:WIILIAM
Other - Middle Name:HENRY
Other - Last Name:GREGORY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:9985 VILLAGE GREEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163
Mailing Address - Country:US
Mailing Address - Phone:410-521-5818
Mailing Address - Fax:443-272-7560
Practice Address - Street 1:9985 VILLAGE GREEN DRIVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:MD
Practice Address - Zip Code:21163
Practice Address - Country:US
Practice Address - Phone:410-521-5818
Practice Address - Fax:443-272-7560
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5741101Y00000X
DC391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional