Provider Demographics
NPI:1952604654
Name:GRUPP, ERIN O'CONNOR (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:O'CONNOR
Last Name:GRUPP
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LAUREL SPRINGS DR
Mailing Address - Street 2:#317
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6714
Mailing Address - Country:US
Mailing Address - Phone:919-244-4109
Mailing Address - Fax:
Practice Address - Street 1:211 E SIX FORKS RD
Practice Address - Street 2:STE. 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7745
Practice Address - Country:US
Practice Address - Phone:919-244-4109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-19
Last Update Date:2010-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0070741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical