Provider Demographics
NPI:1598382301
Name:FLOYD, GRACISHONE LARRIAN
Entity type:Individual
Prefix:
First Name:GRACISHONE
Middle Name:LARRIAN
Last Name:FLOYD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2742 AUGUSTA ST
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-5118
Mailing Address - Country:US
Mailing Address - Phone:504-333-9635
Mailing Address - Fax:
Practice Address - Street 1:2742 AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-5118
Practice Address - Country:US
Practice Address - Phone:504-333-9635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9316101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health