Provider Demographics
NPI:1255902276
Name:GRANDA ANDERSON, KIMBERLY CAROLE (LICSW, PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:CAROLE
Last Name:GRANDA ANDERSON
Suffix:
Gender:F
Credentials:LICSW, PHD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:GRANDA
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LICSW, PIP
Mailing Address - Street 1:6321 TRAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-9415
Mailing Address - Country:US
Mailing Address - Phone:205-886-6182
Mailing Address - Fax:
Practice Address - Street 1:6321 TRAILWOOD DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811-9415
Practice Address - Country:US
Practice Address - Phone:205-886-6182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1556C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical