Provider Demographics
NPI:1497786313
Name:GRADY, ELIZABETH A (LPCS, NCC, DCC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:GRADY
Suffix:
Gender:F
Credentials:LPCS, NCC, DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7253 MANOR OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:919-609-0954
Mailing Address - Fax:919-896-7537
Practice Address - Street 1:16 BERMUDA LANDING PLACE
Practice Address - Street 2:
Practice Address - City:NORTH TOPSAIL BEACH
Practice Address - State:NC
Practice Address - Zip Code:26460
Practice Address - Country:US
Practice Address - Phone:919-609-0954
Practice Address - Fax:919-896-7537
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4766101YM0800X
NC4766S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102727Medicaid