Provider Demographics
NPI:1225603798
Name:GRAYSON, BRIANNA LYNN (MS, LPC, ADC, QSAP I)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LYNN
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:MS, LPC, ADC, QSAP I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 COLUMBIA HWY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-5434
Mailing Address - Country:US
Mailing Address - Phone:334-712-6400
Mailing Address - Fax:334-712-2673
Practice Address - Street 1:1672 COLUMBIA HWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-5434
Practice Address - Country:US
Practice Address - Phone:334-712-6400
Practice Address - Fax:334-712-2673
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4438101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty