Provider Demographics
NPI:1356482921
Name:WEAVER, GRANT (MA, CDP, MAC, LMHC)
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MA, CDP, MAC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 490
Mailing Address - Street 2:BOX 9096
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96538-0490
Mailing Address - Country:US
Mailing Address - Phone:671-344-9266
Mailing Address - Fax:
Practice Address - Street 1:178 FRANCISCO XAVIER DRIVE
Practice Address - Street 2:APARTMENT 9 CLIFF CONDOS & GUEST HOUSE
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-482-6095
Practice Address - Fax:671-344-9522
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002621101YA0400X
WALH00003794101YM0800X
GU101YP1600X
WA4294101YP2500X
GUIMF-97106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist