Provider Demographics
NPI:1508137282
Name:GRANT, OLIVIA ELAINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:ELAINE
Last Name:GRANT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:EALINE
Other - Last Name:CULBRETH
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2015 STAPLES MILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3108
Mailing Address - Country:US
Mailing Address - Phone:804-514-0296
Mailing Address - Fax:
Practice Address - Street 1:2015 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3108
Practice Address - Country:US
Practice Address - Phone:804-514-0296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical