Provider Demographics
NPI:1740694785
Name:PERKINS, GRACE MURETTA (MA, LPC, LCAS-A)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MURETTA
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MA, LPC, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MULLINAX DR
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:NC
Mailing Address - Zip Code:28073-9584
Mailing Address - Country:US
Mailing Address - Phone:704-421-5464
Mailing Address - Fax:704-396-6356
Practice Address - Street 1:436 E LONG AVE STE 1
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2543
Practice Address - Country:US
Practice Address - Phone:980-888-7258
Practice Address - Fax:704-396-6356
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-20091101YA0400X
NC11148101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health