Provider Demographics
NPI:1346789492
Name:GRANT, NAJEMA ERICA (QMHA)
Entity Type:Individual
Prefix:
First Name:NAJEMA
Middle Name:ERICA
Last Name:GRANT
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 LOSEE RD
Mailing Address - Street 2:UNIT 1129
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-2479
Mailing Address - Country:US
Mailing Address - Phone:718-501-0084
Mailing Address - Fax:702-247-4535
Practice Address - Street 1:3365 W CRAIG RD
Practice Address - Street 2:SUITE 9
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5112
Practice Address - Country:US
Practice Address - Phone:702-247-4535
Practice Address - Fax:702-247-4535
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1405596993251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health