Provider Demographics
NPI:1558082958
Name:GRAYDON, COLLEEN L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:L
Last Name:GRAYDON
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 1:6914 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-1525
Mailing Address - Country:US
Mailing Address - Phone:703-517-3260
Mailing Address - Fax:
Practice Address - Street 1:6914 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-1525
Practice Address - Country:US
Practice Address - Phone:703-517-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040138501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical