Provider Demographics
NPI:1982981353
Name:GRAYDON, TREMAYNE (MS, LPC, CPHQ)
Entity type:Individual
Prefix:MR
First Name:TREMAYNE
Middle Name:
Last Name:GRAYDON
Suffix:
Gender:M
Credentials:MS, LPC, CPHQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BEAVERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-5269
Mailing Address - Country:US
Mailing Address - Phone:678-492-8899
Mailing Address - Fax:
Practice Address - Street 1:4151 MEMORIAL DR STE 103A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1511
Practice Address - Country:US
Practice Address - Phone:678-492-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002981101YM0800X
GALPC007943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health