| Gridley Behavioral Healthcare, P.a. | |
|
2100b N Herritage St Kinston NC 28501-2222 | |
| (252) 522-3976 | |
| (252) 522-1582 |
| Full Name | Gridley Behavioral Healthcare, P.a. |
|---|---|
| Speciality | Psychologist |
| Location | 2100b N Herritage St, Kinston, North Carolina |
| Authorized Official Name and Position | Gregory Charles Gridley (PRESIDENT) |
| Authorized Official Contact | 2525223976 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gridley Behavioral Healthcare, P.a. 2100b N. Herritage Street Kinston NC 28501-2222 Ph: (252) 522-3976 | Gridley Behavioral Healthcare, P.a. 2100b N Herritage St Kinston NC 28501-2222 Ph: (252) 522-3976 |
| NPI Number | 1952377749 |
|---|---|
| Provider Enumeration Date | 02/23/2006 |
| Last Update Date | 11/06/2007 |
| Medicare PECOS PAC ID | 4981879046 |
|---|---|
| Medicare Enrollment ID | O20111219000824 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952377749 | NPI | - | NPPES |
| 6000369 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1141 (North Carolina) | Primary |
| Provider Name | Gregory Gridley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518925221 PECOS PAC ID: 5698940765 Enrollment ID: I20111220000363 |
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