Provider Demographics
NPI:1609673409
Name:GRAYSON, ANEESAH
Entity type:Individual
Prefix:
First Name:ANEESAH
Middle Name:
Last Name:GRAYSON
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 1:2235 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-4012
Mailing Address - Country:US
Mailing Address - Phone:510-708-2975
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2712
Practice Address - Country:US
Practice Address - Phone:415-456-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)