Provider Demographics
NPI:1265801757
Name:GRANT, JILL R (PSYD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:R
Last Name:GRANT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 JONES CREEK PL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4357
Mailing Address - Country:US
Mailing Address - Phone:919-604-8979
Mailing Address - Fax:336-686-8050
Practice Address - Street 1:105 JONES CREEK PL
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-4357
Practice Address - Country:US
Practice Address - Phone:919-604-8979
Practice Address - Fax:336-686-8050
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHSP-P 2149103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical