Provider Demographics
NPI:1902498470
Name:GRADY MORALES, MAUREEN ANN (LPC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANN
Last Name:GRADY MORALES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PHARR RD NE STE 410
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3433
Mailing Address - Country:US
Mailing Address - Phone:404-531-6433
Mailing Address - Fax:
Practice Address - Street 1:550 PHARR RD NE STE 410
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3433
Practice Address - Country:US
Practice Address - Phone:404-531-6433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional