Provider Demographics
NPI:1700808961
Name:GRANT, MARY ELIZABETH (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:GRANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:WILLIAMS-WILKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:871 RIDGEWAY LOOP ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120
Mailing Address - Country:US
Mailing Address - Phone:901-871-0170
Mailing Address - Fax:901-871-0353
Practice Address - Street 1:871 RIDGEWAY LOOP ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-871-0170
Practice Address - Fax:901-871-0353
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3350101YP2500X
MSMSLPC0311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health