Provider Demographics
NPI:1285655704
Name:GRAYSON, RITA (LCSW)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 WINTERGATE CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5584
Mailing Address - Country:US
Mailing Address - Phone:770-417-1004
Mailing Address - Fax:770-840-0162
Practice Address - Street 1:5000 RESEARCH CT
Practice Address - Street 2:SUITE 725
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6609
Practice Address - Country:US
Practice Address - Phone:678-557-4144
Practice Address - Fax:770-840-0162
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0295751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00968734AMedicaid