Provider Demographics
NPI:1982452322
Name:GRANT, ALISHA (LCSW,SSW)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:LCSW,SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10040 PIERSON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1285
Mailing Address - Country:US
Mailing Address - Phone:313-960-6460
Mailing Address - Fax:
Practice Address - Street 1:15850 STRATHMOOR ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-2965
Practice Address - Country:US
Practice Address - Phone:313-416-4885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011166011041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool