Provider Demographics
NPI:1285649061
Name:GRANTHAM, VICTORIA V (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:V
Last Name:GRANTHAM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GLENWAY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3173
Mailing Address - Country:US
Mailing Address - Phone:704-829-2005
Mailing Address - Fax:704-829-2006
Practice Address - Street 1:100 GLENWAY ST
Practice Address - Street 2:SUITE B
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3173
Practice Address - Country:US
Practice Address - Phone:704-829-2005
Practice Address - Fax:704-829-2006
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0053621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7668724Medicare UPIN