Provider Demographics
NPI:1508942483
Name:PRESTON, GREGORY VICTOR (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:VICTOR
Last Name:PRESTON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:MR
Other - First Name:GREGORY
Other - Middle Name:VICTOR
Other - Last Name:PIATEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,LPC
Mailing Address - Street 1:17916 CALDWELL TRACK DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8142
Mailing Address - Country:US
Mailing Address - Phone:704-787-1793
Mailing Address - Fax:
Practice Address - Street 1:1945 J N PEASE PL
Practice Address - Street 2:STE. 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4505
Practice Address - Country:US
Practice Address - Phone:704-787-1793
Practice Address - Fax:704-548-0036
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4874101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2295328OtherCIGNA
NC56162OtherMEDCOST
NC4498835OtherAETNA
NC6103379Medicaid
NC1435JOtherBLUE CROSS BLUE SHEILD