Gravitte, Mandy W

Gravitte, Mandy W is an individual health care provider with primary practice located at 140 Franklin St , Mount Airy NC 27030-4502. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Gravitte, Mandy W can be contacted via phone (336) 755-2085.

Contact Information

Primary practice address
140 Franklin St Mount Airy NC 27030-4502
Phone: (336) 755-2085
Fax: (336) 755-2086
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X C006569 North Carolina
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 2324-A North Carolina

Profile Details

NPI number 1730415894
LBN Legal business name Gravitte, Mandy W
Credentials LCSW, LCAS-A
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 26th, 2009
Last updated Nov 13th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730415894 NPPES
North Carolina MEDICAID 6007450
North Carolina Other 2853446

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