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Organization
MAHOGANY PLACE PLLC
Active
Organization
MAHOGANY PLACE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLISHA GRAY MSW, LCSW (ORGANIZER/MEMBER)
(910) 808-1881
Entity
Organization
Contact information
Practice address
125 BELLA HOWINGTON DR, LILLINGTON, NC 27546-5666
(910) 808-1881
Mailing address
125 BELLA HOWINGTON DR, LILLINGTON, NC 27546-5666
(910) 808-1881
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
09/27/2019
Last updated
09/27/2019
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