Provider Demographics
NPI:1679589097
Name:GRANT, JEANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 OAK HARBOR BLVD 101
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8862
Mailing Address - Country:US
Mailing Address - Phone:985-788-1374
Mailing Address - Fax:985-276-3391
Practice Address - Street 1:620 OAK HARBOR
Practice Address - Street 2:SUITE 101
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8862
Practice Address - Country:US
Practice Address - Phone:985-788-1374
Practice Address - Fax:985-276-3391
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8143104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker