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Individual

AMY GRAY THERRIAULT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCMHC, BSN, RN

Contact information

Practice address
340 SANDY RIDGE RD, DUNN, NC 28334-8824
(252) 665-3071
Mailing address
340 SANDY RIDGE RD, DUNN, NC 28334-8824
(252) 665-3071

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
17859
NC
101YM0800X
Mental Health Counselor
Primary
A17859
NC
163W00000X
Registered Nurse
233656
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
A17859
NORTH CAROLINA BOARD OF LICENSED CLINICAL MENTAL HEALTH COUNSELORS
NC
Enumeration date
07/25/2022
Last updated
04/07/2026
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