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General NPI Number Information
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NPI Number | 1891018628
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Entity Type | Individual
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Provider Name | ANGELA M GRAYSON LPC, BC-DMT, NCC
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Gender | Female
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 06/28/2024
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Provider Practice Location Address
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Address Line | 222 PHILADELPHIA PIKE STE 7
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City | WILMINGTON
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State | DE
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Zip | 19809-3166
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Country | US
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Telephone | 888-440-2712
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Fax | 888-440-2712
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Provider Business Mailing Address
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Address Line | 7209 LANCASTER PIKE STE 4-1133
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City | HOCKESSIN
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State | DE
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Zip | 19707-9292
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Country | US
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Telephone | 888-440-2712
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Fax | 888-440-2712
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC005056
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number | BC-DMT 1008
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC0000438
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License Number State | DE
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