Individual
MR. GRADY BLUE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
39 MAR JOY RD, DUNN, NC 28334-5070
(910) 892-2279
(910) 892-3657
Mailing address
39 MAR JOY RD, DUNN, NC 28334-5070
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
788
NC
Other
Enumeration date
09/09/2011
Last updated
09/09/2011
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