Provider Demographics
NPI:1649249194
Name:GRADY-THOMAS, HARRIETT WILLS (LISW)
Entity type:Individual
Prefix:MS
First Name:HARRIETT
Middle Name:WILLS
Last Name:GRADY-THOMAS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 NORTHBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3742
Mailing Address - Country:US
Mailing Address - Phone:843-571-3387
Mailing Address - Fax:843-571-4387
Practice Address - Street 1:4 CARRIAGE LN
Practice Address - Street 2:SUITE 108
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6065
Practice Address - Country:US
Practice Address - Phone:843-571-3387
Practice Address - Fax:843-571-4387
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical