Provider Demographics
NPI:1801650403
Name:GRANT, BENITA
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:
Last Name:GRANT
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 1:3695 SUNSET AVE UNIT 7072
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0105
Mailing Address - Country:US
Mailing Address - Phone:252-606-4484
Mailing Address - Fax:252-606-4033
Practice Address - Street 1:117 OPOSSUM TROT CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-9072
Practice Address - Country:US
Practice Address - Phone:252-200-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator