Provider Demographics
NPI:1548775182
Name:ANTHONY, GRETCHEN (MSW)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17105 KENTON DR STE 201C
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5654
Mailing Address - Country:US
Mailing Address - Phone:980-689-2682
Mailing Address - Fax:
Practice Address - Street 1:17105 KENTON DRIVE
Practice Address - Street 2:SUITE 201C
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031
Practice Address - Country:US
Practice Address - Phone:980-689-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCO102351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical