Provider Demographics
NPI:1518492537
Name:GRADY, TRISHA LAYNE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:LAYNE
Last Name:GRADY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 FARTHING ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4234
Mailing Address - Country:US
Mailing Address - Phone:714-331-2777
Mailing Address - Fax:
Practice Address - Street 1:2109 FARTHING ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-4234
Practice Address - Country:US
Practice Address - Phone:714-331-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0105341041C0700X
NCC0114711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical