Provider Demographics
NPI:1992381776
Name:GRAYSON, CATHERINE (RBT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 SANDY CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3008
Mailing Address - Country:US
Mailing Address - Phone:770-925-5551
Mailing Address - Fax:
Practice Address - Street 1:2615 SANDY CREEK CIR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3008
Practice Address - Country:US
Practice Address - Phone:770-925-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-21-160995106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician