Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 172 | WV |
N | 101YM0800X | Mental Health Counselor | 172 | WV |
NPI | 1003019274 |
---|---|
Provider Name | Ms. Emily Joyce Grandusky |
First Address | Junior, WV 26275-0324 |
Second Address | Junior, WV 26275-0324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 15/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0023397001 | (05) | WV |