Provider Demographics
NPI:1952873945
Name:GRAIN OF SAND ACADEMY
Entity Type:Organization
Organization Name:GRAIN OF SAND ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-982-9436
Mailing Address - Street 1:342 THE CHACE
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4246
Mailing Address - Country:US
Mailing Address - Phone:570-982-9436
Mailing Address - Fax:678-669-2632
Practice Address - Street 1:342 THE CHACE
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4246
Practice Address - Country:US
Practice Address - Phone:570-982-9436
Practice Address - Fax:678-669-2632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty