Provider Demographics
NPI:1912195991
Name:GRANT, MERINDAR J (LPC, LBSW & CAADC)
Entity Type:Individual
Prefix:MRS
First Name:MERINDAR
Middle Name:J
Last Name:GRANT
Suffix:
Gender:F
Credentials:LPC, LBSW & CAADC
Other - Prefix:MS
Other - First Name:MERINDAR
Other - Middle Name:J
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LBSW & CAADC
Mailing Address - Street 1:55440 FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5417
Mailing Address - Country:US
Mailing Address - Phone:586-216-6031
Mailing Address - Fax:586-781-5985
Practice Address - Street 1:55440 FRANCIS DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-5417
Practice Address - Country:US
Practice Address - Phone:586-216-6031
Practice Address - Fax:586-781-5985
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009752101YP2500X, 101YM0800X
MIC-00170101YA0400X
MI6802085439104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health