Provider Demographics
NPI:1467968057
Name:GRANT, CAROLYN WILLIAMS (MSW,PCMHT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:WILLIAMS
Last Name:GRANT
Suffix:
Gender:F
Credentials:MSW,PCMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 BROWNING ROAD 520
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-6022
Mailing Address - Country:US
Mailing Address - Phone:662-332-5274
Mailing Address - Fax:662-378-3976
Practice Address - Street 1:1654 E UNION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3250
Practice Address - Country:US
Practice Address - Phone:662-335-5274
Practice Address - Fax:662-378-3976
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPH4056101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health