Provider Demographics
NPI:1235011602
Name:PEGRAM, LORI GWEN (LCMHC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:GWEN
Last Name:PEGRAM
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 SPRING GARDEN ST UNIT G
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2746
Mailing Address - Country:US
Mailing Address - Phone:336-251-8760
Mailing Address - Fax:
Practice Address - Street 1:614 MORGAN COUNTRY RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-8342
Practice Address - Country:US
Practice Address - Phone:336-629-9589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21766101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health