1386370237 NPI number — AMANDA GRAY GRUBB LCSW-A, LCAS-A

Table of content: AMANDA GRAY GRUBB LCSW-A, LCAS-A (NPI 1386370237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386370237 NPI number — AMANDA GRAY GRUBB LCSW-A, LCAS-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRUBB
Provider First Name:
AMANDA
Provider Middle Name:
GRAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-A, LCAS-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386370237
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 5TH AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28792-4377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-692-4289
Provider Business Mailing Address Fax Number:
828-696-1794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
69 N BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREVARD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28712-3725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-631-3973
Provider Business Practice Location Address Fax Number:
828-631-9280
Provider Enumeration Date:
07/25/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LCAS-28343 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: P018499 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)