Provider Demographics
NPI:1649860156
Name:GRANDERSON, ASHANTI RUSHAWN
Entity type:Individual
Prefix:MRS
First Name:ASHANTI
Middle Name:RUSHAWN
Last Name:GRANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 W NAPOLEON AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2667
Mailing Address - Country:US
Mailing Address - Phone:504-756-2541
Mailing Address - Fax:
Practice Address - Street 1:3701 W NAPOLEON AVE APT 318
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2675
Practice Address - Country:US
Practice Address - Phone:504-756-2541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health