Provider Demographics
NPI:1265890008
Name:GRANELLE, KIMBERLY (LCAS-A, NCC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GRANELLE
Suffix:
Gender:F
Credentials:LCAS-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MCDOWELL ST
Mailing Address - Street 2:STE 300
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4453
Mailing Address - Country:US
Mailing Address - Phone:828-785-1889
Mailing Address - Fax:
Practice Address - Street 1:131 MCDOWELL ST
Practice Address - Street 2:STE 300
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4453
Practice Address - Country:US
Practice Address - Phone:828-785-1889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-22263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health