Provider Demographics
NPI:1780297572
Name:GRADY, QYONNA I (LMSW)
Entity type:Individual
Prefix:
First Name:QYONNA
Middle Name:I
Last Name:GRADY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1252
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-5252
Mailing Address - Country:US
Mailing Address - Phone:256-384-5135
Mailing Address - Fax:
Practice Address - Street 1:106 COTTON BOLL DR NW
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35757-6948
Practice Address - Country:US
Practice Address - Phone:256-508-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA166241041C0700X
AL5227C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical