Provider Demographics
NPI:1053579789
Name:GRAYSON, BARIKA (LMHC, NCC, CCM)
Entity type:Individual
Prefix:
First Name:BARIKA
Middle Name:
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:LMHC, NCC, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7235 BENTLEY RD STE 106
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7506
Mailing Address - Country:US
Mailing Address - Phone:904-413-1379
Mailing Address - Fax:904-677-7886
Practice Address - Street 1:7235 BENTLEY RD STE 106
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7506
Practice Address - Country:US
Practice Address - Phone:904-413-1379
Practice Address - Fax:904-677-7886
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLMH9952101YP2500X, 101YM0800X
4210365171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006491400Medicaid