Provider Demographics
NPI:1841405818
Name:GRANT, BARBARA (LCSW, BCD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:LLEWELLYN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:505 FAULCONER DR
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4981
Mailing Address - Country:US
Mailing Address - Phone:434-295-6777
Mailing Address - Fax:434-973-8080
Practice Address - Street 1:505 FAULCONER DR
Practice Address - Street 2:SUITE 2D
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4981
Practice Address - Country:US
Practice Address - Phone:434-295-6777
Practice Address - Fax:434-973-8080
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040001671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA11526185OtherCAQH