Provider Demographics
NPI:1730661034
Name:GRANT, TITANIA (LPC)
Entity Type:Individual
Prefix:
First Name:TITANIA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3310
Mailing Address - Country:US
Mailing Address - Phone:973-226-2852
Mailing Address - Fax:973-251-5967
Practice Address - Street 1:28 VALLEY RD STE 150
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2709
Practice Address - Country:US
Practice Address - Phone:973-226-2852
Practice Address - Fax:973-251-5967
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00679600101YP2500X
NJ37AC00284800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health