Provider Demographics
NPI:1245963016
Name:GRANT, JILLIAN M (LCMHC-A, LCAS-A)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:M
Last Name:GRANT
Suffix:
Gender:F
Credentials:LCMHC-A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51461
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27717-1461
Mailing Address - Country:US
Mailing Address - Phone:973-444-6557
Mailing Address - Fax:
Practice Address - Street 1:940 SE CARY PKWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7417
Practice Address - Country:US
Practice Address - Phone:855-939-6663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27963101YA0400X
NCGRAN-L4K88C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)