Provider Demographics
NPI:1023820099
Name:GRANT, CHAVONNE SHARESE (LCSW)
Entity type:Individual
Prefix:
First Name:CHAVONNE
Middle Name:SHARESE
Last Name:GRANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHAVONNE
Other - Middle Name:SHARESE
Other - Last Name:GRANT-BARTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1832 KEMPSVILLE RD
Mailing Address - Street 2:STE 112 #347
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6861
Mailing Address - Country:US
Mailing Address - Phone:718-872-8833
Mailing Address - Fax:
Practice Address - Street 1:1832 KEMPSVILLE RD
Practice Address - Street 2:STE 112 #347
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6861
Practice Address - Country:US
Practice Address - Phone:718-872-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040162861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical