Provider Demographics
NPI:1700603412
Name:GRESOCK, JOYCE
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:GRESOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 TOWERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3595
Mailing Address - Country:US
Mailing Address - Phone:919-585-5085
Mailing Address - Fax:919-585-5085
Practice Address - Street 1:120 TOWERVIEW CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3595
Practice Address - Country:US
Practice Address - Phone:919-585-5085
Practice Address - Fax:919-585-5085
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20578101YM0800X
NC1292826101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool