Organization
CAROLINA PSYCHOLOGY GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL BEMISS GRAY PSYD (OWNER)
(336) 276-1278
Entity
Organization
Contact information
Practice address
100 S MARSHALL ST STE 1, WINSTON SALEM, NC 27101-2843
(336) 276-1278
(336) 276-1516
Mailing address
100 S MARSHALL ST STE 1, WINSTON SALEM, NC 27101-2843
(336) 276-1278
(336) 276-1516
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
02/01/2019
Last updated
04/04/2022
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