Provider Demographics
NPI:1417532169
Name:GRAYMAN, NASIR TREVON (LCMHCA)
Entity Type:Individual
Prefix:
First Name:NASIR
Middle Name:TREVON
Last Name:GRAYMAN
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 S SHARON AMITY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2836
Mailing Address - Country:US
Mailing Address - Phone:980-299-7436
Mailing Address - Fax:980-226-5507
Practice Address - Street 1:447 S SHARON AMITY RD STE 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2836
Practice Address - Country:US
Practice Address - Phone:980-299-7436
Practice Address - Fax:980-226-5507
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16386101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health