MEDICARE: LINETTE KAY GRADDIC LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	C.1000180	OH
2	101YM0800X	Mental Health Counselor	C.1000180	OH
3	101YP1600X	Pastoral Counselor	C.1000180	OH
4	101YP2500X	Professional Counselor	C.1000180	OH
5	101Y00000X	Counselor	C.1000180	OH

General Provider Information

NPI Number	:	1124378062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINETTE KAY GRADDIC LPC

Provider Business Mailing Address
First Line	:	3 SEVERANCE CIR UNIT 18305
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-5317
Country	:	US
Telephone Number	:	216-214-2201
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 S MORELAND BLVD STE 202
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-2397
Country	:	US
Telephone Number	:	216-459-7222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	03/15/2019

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Directions to “ LINETTE KAY GRADDIC LPC” Practice Location

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