Provider Demographics
NPI:1073210498
Name:GRANT, LAURA KELSEY (LICSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KELSEY
Last Name:GRANT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 BONNIEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-3646
Mailing Address - Country:US
Mailing Address - Phone:334-695-5439
Mailing Address - Fax:
Practice Address - Street 1:177 BONNIEVILLE DR
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-3646
Practice Address - Country:US
Practice Address - Phone:334-695-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5248C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical