Provider Demographics
NPI:1831305911
Name:GRANT, KATHLEEN A (MA, CAC- 1, LLP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:GRANT
Suffix:
Gender:F
Credentials:MA, CAC- 1, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-2134
Mailing Address - Country:US
Mailing Address - Phone:517-279-1587
Mailing Address - Fax:
Practice Address - Street 1:316 E CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2068
Practice Address - Country:US
Practice Address - Phone:517-279-5337
Practice Address - Fax:517-279-5391
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002951101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)