Provider Demographics
NPI:1922674852
Name:GRALLEY, ROBERT (LGPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GRALLEY
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 E RIDGEVILLE BLVD # 312
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5201
Mailing Address - Country:US
Mailing Address - Phone:202-750-1028
Mailing Address - Fax:
Practice Address - Street 1:327 E RIDGEVILLE BLVD
Practice Address - Street 2:#312
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5201
Practice Address - Country:US
Practice Address - Phone:202-750-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health