Provider Demographics
NPI:1265945422
Name:GROSS, EMILEA (LPC-A)
Entity type:Individual
Prefix:
First Name:EMILEA
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 CARSON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-9693
Mailing Address - Country:US
Mailing Address - Phone:434-250-1808
Mailing Address - Fax:
Practice Address - Street 1:592 CARSON RIDGE DR
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-9693
Practice Address - Country:US
Practice Address - Phone:434-250-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor