Provider Demographics
NPI:1104853530
Name:GRANT-JAMES, DEBORAH L (LPC)
Entity Type:Individual
Prefix:PROF
First Name:DEBORAH
Middle Name:L
Last Name:GRANT-JAMES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 COLNBROOK RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2511
Mailing Address - Country:US
Mailing Address - Phone:803-407-3517
Mailing Address - Fax:803-407-3517
Practice Address - Street 1:3604 FERNANDINA RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5221
Practice Address - Country:US
Practice Address - Phone:803-750-9400
Practice Address - Fax:803-407-3517
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1633101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCWP9969Medicaid