Provider Demographics
NPI:1275754665
Name:GRANT, WINONA ANN
Entity Type:Individual
Prefix:MS
First Name:WINONA
Middle Name:ANN
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-4250
Mailing Address - Country:US
Mailing Address - Phone:530-666-5588
Mailing Address - Fax:
Practice Address - Street 1:435 ASPEN ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2665
Practice Address - Country:US
Practice Address - Phone:530-662-5727
Practice Address - Fax:530-668-1198
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)