Provider Demographics
NPI:1629336870
Name:GRANT, CHRISTINE MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:GRANT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:DULAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:587 MIDDLE TPKE E
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-3731
Mailing Address - Country:US
Mailing Address - Phone:860-646-3888
Mailing Address - Fax:860-645-4132
Practice Address - Street 1:587 MIDDLE TPKE E
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3731
Practice Address - Country:US
Practice Address - Phone:860-646-3888
Practice Address - Fax:860-645-4132
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health