Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CP00002621 | WA |
N | 101YM0800X | Mental Health Counselor | LH00003794 | WA |
N | 101YP1600X | Pastoral Counselor | GU | |
N | 101YP2500X | Professional Counselor | 4294 | WA |
NPI | 1356482921 |
---|---|
Provider Name | Mr. Grant Weaver |
First Address | Fpo, AP 96538-0490 |
Second Address | Agana Heights, GU 96910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 13/04/2011 |