Provider Demographics
NPI:1720488331
Name:GRANT, SHARAY T (ACSW)
Entity Type:Individual
Prefix:MS
First Name:SHARAY
Middle Name:T
Last Name:GRANT
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43845 10TH ST W STE 2B
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4800
Mailing Address - Country:US
Mailing Address - Phone:661-940-9094
Mailing Address - Fax:661-951-1030
Practice Address - Street 1:43845 10TH ST W STE 2B
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4800
Practice Address - Country:US
Practice Address - Phone:661-940-9094
Practice Address - Fax:661-951-1030
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACSW 69528101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health