Provider Demographics
NPI:1770844276
Name:GRANDLIENARD, ANGELA JOYCE (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JOYCE
Last Name:GRANDLIENARD
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:JOYCE
Other - Last Name:HINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:2522 E QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-4728
Mailing Address - Country:US
Mailing Address - Phone:517-740-6663
Mailing Address - Fax:
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT
Practice Address - State:IN
Practice Address - Zip Code:46928-1923
Practice Address - Country:US
Practice Address - Phone:765-293-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health