Healthcare Provider Details

I. General information

NPI: 1407296031
Provider Name (Legal Business Name): NYASHA GRAYMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WEST RD STE 300
TOWSON MD
21204-2370
US

IV. Provider business mailing address

9439 PARAGON CT
OWINGS MILLS MD
21117-1408
US

V. Phone/Fax

Practice location:
  • Phone: 667-206-3685
  • Fax:
Mailing address:
  • Phone: 667-206-3685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC12281
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: