Healthcare Provider Details

I. General information

NPI: 1275204372
Provider Name (Legal Business Name): DANIELLE E GRADY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 NORTH POINT RD
BALTIMORE MD
21224-3338
US

IV. Provider business mailing address

1012 NORTH POINT RD
BALTIMORE MD
21224-3338
US

V. Phone/Fax

Practice location:
  • Phone: 443-206-1293
  • Fax:
Mailing address:
  • Phone: 443-216-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP11948
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: