Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC005539 | GA |
NPI | 1003130766 |
---|---|
Provider Name | Nia Jowan Grant |
First Address | Marietta, GA 30008-6095 |
Second Address | Marietta, GA 30008-6095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2010 |
Last Update Date | 23/03/2010 |