Provider Demographics
NPI:1225787823
Name:GRANGENT, LETITIA KESHAUN (MS, MED, LPC)
Entity Type:Individual
Prefix:
First Name:LETITIA
Middle Name:KESHAUN
Last Name:GRANGENT
Suffix:
Gender:F
Credentials:MS, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 SUMMIT BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-6422
Mailing Address - Country:US
Mailing Address - Phone:414-424-4266
Mailing Address - Fax:405-520-6633
Practice Address - Street 1:2083 PEMBERTON RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2522
Practice Address - Country:US
Practice Address - Phone:404-401-7674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012772101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional