Provider Demographics
NPI:1457497786
Name:GRANDIS, MICHAEL STEWART (MA, LPA)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEWART
Last Name:GRANDIS
Suffix:
Gender:M
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 TUNNEL ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805
Mailing Address - Country:US
Mailing Address - Phone:828-299-7451
Mailing Address - Fax:828-299-7454
Practice Address - Street 1:1011 TUNNEL ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805
Practice Address - Country:US
Practice Address - Phone:828-299-7451
Practice Address - Fax:828-299-7454
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL.P.A. 2157103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046G3OtherBLUE CROSS BLUE SHIELD
NC6107122Medicaid