Provider Demographics
NPI:1821105024
Name:ARRAN Y GREGG LLC
Entity Type:Organization
Organization Name:ARRAN Y GREGG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER AND ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:ARRAN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-341-0078
Mailing Address - Street 1:3491 EVANS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4534
Mailing Address - Country:US
Mailing Address - Phone:252-341-0078
Mailing Address - Fax:252-321-7840
Practice Address - Street 1:3491 EVANS ST
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4534
Practice Address - Country:US
Practice Address - Phone:252-341-0078
Practice Address - Fax:252-321-7840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0042171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005899Medicaid
NC6005899Medicaid