Provider Demographics
NPI:1558869065
Name:GRAYBEAL, DENISE (LMSW, LMT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:GRAYBEAL
Suffix:
Gender:F
Credentials:LMSW, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 HICKORY RIDGE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3871
Mailing Address - Country:US
Mailing Address - Phone:301-706-2496
Mailing Address - Fax:
Practice Address - Street 1:1102 WAYBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7856
Practice Address - Country:US
Practice Address - Phone:301-706-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04281225700000X
GAMT014041225700000X
MD29122104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist