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General NPI Number Information
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NPI Number | 1336855279
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Entity Type | Organization
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Legal Business Name | LINDA GRAYSON LCSW LLC
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 820 JORDAN ST STE 570
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City | SHREVEPORT
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State | LA
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Zip | 71101-4512
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Country | US
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Telephone | 318-221-4455
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Fax | 318-221-5599
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Provider Business Mailing Address
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Address Line | 820 JORDAN ST STE 570
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City | SHREVEPORT
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State | LA
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Zip | 71101-4512
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Country | US
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Telephone | 318-221-4455
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Fax | 318-221-5599
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Authorized Official
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Title or Position | PROVIDER
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Name | LINDA I GRAYSON
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Credential | LCSW
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Telephone | 318-840-5880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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