Provider Demographics
NPI:1316385438
Name:LAUREN M. GRANTHAM
Entity Type:Organization
Organization Name:LAUREN M. GRANTHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC-A
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GRANTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC, LPC-A
Authorized Official - Phone:919-394-1637
Mailing Address - Street 1:1807 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-5330
Mailing Address - Country:US
Mailing Address - Phone:919-731-2119
Mailing Address - Fax:
Practice Address - Street 1:1807 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-5330
Practice Address - Country:US
Practice Address - Phone:919-731-2119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10094305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service