Provider Demographics
NPI:1275103327
Name:GRANT, TIESHA FARMER (LCSWA)
Entity Type:Individual
Prefix:
First Name:TIESHA
Middle Name:FARMER
Last Name:GRANT
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 MURRAYLANE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-7620
Mailing Address - Country:US
Mailing Address - Phone:704-885-4092
Mailing Address - Fax:
Practice Address - Street 1:560 PROGRESS BLVD
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-6783
Practice Address - Country:US
Practice Address - Phone:919-742-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0161731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical