Provider Demographics
NPI:1760896575
Name:GRANT, AYANA UTAMU (LCSW)
Entity Type:Individual
Prefix:
First Name:AYANA
Middle Name:UTAMU
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 1:530 N ST SW APT S408
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-4559
Mailing Address - Country:US
Mailing Address - Phone:240-406-7606
Mailing Address - Fax:
Practice Address - Street 1:530 N ST SW APT S408
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-4559
Practice Address - Country:US
Practice Address - Phone:240-406-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2022-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0180381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical