Provider Demographics
NPI:1033474010
Name:GRANT, STEPHANIE D (MS)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:D
Last Name:GRANT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 WHEELER RD
Mailing Address - Street 2:SUITE 619
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1871
Mailing Address - Country:US
Mailing Address - Phone:706-733-0333
Mailing Address - Fax:706-733-0313
Practice Address - Street 1:3540 WHEELER RD
Practice Address - Street 2:SUITE 619
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1871
Practice Address - Country:US
Practice Address - Phone:706-733-0333
Practice Address - Fax:706-733-0313
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health