MEDICARE: MS. ELIZABETH A GRADY LPCS, NCC, DCC

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	101YM0800X	Mental Health Counselor	4766	NC
2	101YM0800X	Mental Health Counselor	4766S	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497786313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH A GRADY LPCS, NCC, DCC

Provider Business Mailing Address
First Line	:	7253 MANOR OAKS DRIVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615
Country	:	US
Telephone Number	:	919-609-0954
Fax Number	:	919-896-7537

Provider Business Practice Location Address
First Line	:	16 BERMUDA LANDING PLACE
Second Line	:
City	:	NORTH TOPSAIL BEACH
State	:	NC
Zip	:	26460
Country	:	US
Telephone Number	:	919-609-0954
Fax Number	:	919-896-7537

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	03/17/2017

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