Provider Demographics
NPI:1801170402
Name:GRANT, ERICA MICHELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:MICHELLE
Last Name:GRANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:MICHELLE
Other - Last Name:KEYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3415 OLD 41 HIGHWAY STE 750
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1028
Mailing Address - Country:US
Mailing Address - Phone:678-574-8313
Mailing Address - Fax:678-574-8315
Practice Address - Street 1:3415 OLD 41 HIGHWAY STE 750
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1028
Practice Address - Country:US
Practice Address - Phone:785-748-3163
Practice Address - Fax:678-574-8315
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-01
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0043161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical