Healthcare Provider Details

I. General information

NPI: 1194772442
Provider Name (Legal Business Name): GRAYSON AND ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 LAKESHORE DR STE 150
BIRMINGHAM AL
35209-8832
US

IV. Provider business mailing address

2200 LAKESHORE DRIVE SUITE 150
BIRMINGHAM AL
35209
US

V. Phone/Fax

Practice location:
  • Phone: 205-871-6926
  • Fax: 205-871-7981
Mailing address:
  • Phone: 205-871-6926
  • Fax: 205-868-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH LUCAS
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 205-871-6926