Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 115 | NC |
NPI | 1275170375 |
---|---|
Provider Name | Kenneth Grano |
First Address | Matthews, NC 28105-2031 |
Second Address | Cornelius, NC 28031-8193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2019 |
Last Update Date | 08/12/2019 |