Provider Demographics
NPI:1457008880
Name:BASS, ALEXANDER GREY (LCMHC)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GREY
Last Name:BASS
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:ELM CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27822-9637
Mailing Address - Country:US
Mailing Address - Phone:252-382-3103
Mailing Address - Fax:
Practice Address - Street 1:4003 NASH ST NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1130
Practice Address - Country:US
Practice Address - Phone:252-640-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-06
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17386101YM0800X
NCA17386101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health