Provider Demographics
NPI:1952697146
Name:GRANT, BRIA (BRIA)
Entity Type:Individual
Prefix:
First Name:BRIA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:BRIA
Other - Prefix:
Other - First Name:BRIA
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAC-IT
Mailing Address - Street 1:3520 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1408
Mailing Address - Country:US
Mailing Address - Phone:414-793-8531
Mailing Address - Fax:
Practice Address - Street 1:3520 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1408
Practice Address - Country:US
Practice Address - Phone:414-793-8531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15555-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)