Healthcare Provider Details

I. General information

NPI: 1124378062
Provider Name (Legal Business Name): LINETTE KAY GRADDIC LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 S MORELAND BLVD STE 202
CLEVELAND OH
44120-2397
US

IV. Provider business mailing address

3 SEVERANCE CIR UNIT 18305
CLEVELAND HEIGHTS OH
44118-5317
US

V. Phone/Fax

Practice location:
  • Phone: 216-459-7222
  • Fax:
Mailing address:
  • Phone: 216-214-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1000180
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC.1000180
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1000180
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberC.1000180
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1000180
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: