Provider Demographics
NPI:1366011769
Name:GRANT, AIMEE (CDCA179342)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:CDCA179342
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 STELLA CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1011
Mailing Address - Country:US
Mailing Address - Phone:614-252-8402
Mailing Address - Fax:614-252-7987
Practice Address - Street 1:455 E MOUND ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5595
Practice Address - Country:US
Practice Address - Phone:614-252-8402
Practice Address - Fax:614-252-7987
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.175034101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCDCA.175034OtherOH LICENSING BOARD