Provider Demographics
NPI:1336855279
Name:LINDA GRAYSON LCSW LLC
Entity Type:Organization
Organization Name:LINDA GRAYSON LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:I
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-840-5880
Mailing Address - Street 1:820 JORDAN ST STE 570
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4512
Mailing Address - Country:US
Mailing Address - Phone:318-221-4455
Mailing Address - Fax:318-221-5599
Practice Address - Street 1:820 JORDAN ST STE 570
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4512
Practice Address - Country:US
Practice Address - Phone:318-221-4455
Practice Address - Fax:318-221-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty