| Mahogany Place Pllc | |
|
125 Bella Howington Dr Lillington NC 27546-5666 | |
| (910) 808-1881 | |
| Not Available |
| Full Name | Mahogany Place Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 125 Bella Howington Dr, Lillington, North Carolina |
| Authorized Official Name and Position | Kellisha Gray (ORGANIZER/MEMBER) |
| Authorized Official Contact | 9108081881 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mahogany Place Pllc 125 Bella Howington Dr Lillington NC 27546-5666 Ph: (910) 808-1881 | Mahogany Place Pllc 125 Bella Howington Dr Lillington NC 27546-5666 Ph: (910) 808-1881 |
| NPI Number | 1740831981 |
|---|---|
| Provider Enumeration Date | 09/27/2019 |
| Last Update Date | 09/27/2019 |
| Medicare PECOS PAC ID | 6507217221 |
|---|---|
| Medicare Enrollment ID | O20240108000850 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740831981 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kellisha Gray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992173355 PECOS PAC ID: 9830457191 Enrollment ID: I20240403001018 |
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