Provider Demographics
NPI:1720201593
Name:VILLAROSA, GREGORY ARTHUR (PHD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ARTHUR
Last Name:VILLAROSA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 CHURCH ST N
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4322
Mailing Address - Country:US
Mailing Address - Phone:704-262-3806
Mailing Address - Fax:
Practice Address - Street 1:611 CHURCH ST N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4322
Practice Address - Country:US
Practice Address - Phone:704-262-3806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1667103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical