Provider Demographics
NPI:1700679586
Name:BRINSON, CAROLINE GRAY
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:GRAY
Last Name:BRINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CAROLINE
Other - Middle Name:GRAY
Other - Last Name:RIVENBARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4429 OLD TOWNE ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-5009
Mailing Address - Country:US
Mailing Address - Phone:910-599-8653
Mailing Address - Fax:910-599-8653
Practice Address - Street 1:890 S KERR AVE STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4248
Practice Address - Country:US
Practice Address - Phone:910-599-8653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health