Provider Demographics
NPI:1992868335
Name:GRAPENTHIN, LUCINDA TAYLOR (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUCINDA
Middle Name:TAYLOR
Last Name:GRAPENTHIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10475 MEDLOCK BRIDGE RD
Mailing Address - Street 2:BUILDING 300 SUITE 315
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10475 MEDLOCK BRIDGE RD
Practice Address - Street 2:BUILDING 300 SUITE 315
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2002
Practice Address - Country:US
Practice Address - Phone:404-433-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2289103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00922556AMedicaid