Provider Demographics
NPI:1609010362
Name:GROSS, JAMES NATHAN (MS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:NATHAN
Last Name:GROSS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3606
Mailing Address - Country:US
Mailing Address - Phone:919-599-3217
Mailing Address - Fax:
Practice Address - Street 1:301 KILMAYNE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4491
Practice Address - Country:US
Practice Address - Phone:919-467-1267
Practice Address - Fax:919-467-1268
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-26
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3931101YP2500X
101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool