Provider Demographics
NPI:1326545997
Name:GRAYES, MARIO (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:GRAYES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15444
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2144
Mailing Address - Country:US
Mailing Address - Phone:912-704-9026
Mailing Address - Fax:
Practice Address - Street 1:101 E MEMORIAL DR STE B
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2728
Practice Address - Country:US
Practice Address - Phone:912-876-4010
Practice Address - Fax:912-369-2262
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health