Healthcare Provider Details

I. General information

NPI: 1528858313
Provider Name (Legal Business Name): KRYSTA GRAYSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BRYDEN RD STE 128
COLUMBUS OH
43215-4839
US

IV. Provider business mailing address

296 CULLMAN RD
COLUMBUS OH
43207-3022
US

V. Phone/Fax

Practice location:
  • Phone: 614-462-0236
  • Fax:
Mailing address:
  • Phone: 614-462-0236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.190908
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.006241
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: