Individual
CRYSTAL ADRAINE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1512 SUNBOW FALLS LN, 301, RALEIGH, NC 27609-8130
(919) 841-6267
Mailing address
PO BOX 20543, RALEIGH, NC 27619-0543
(919) 841-6267
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3128-A
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3128-A
LCASA
NC
Enumeration date
05/07/2013
Last updated
05/07/2013
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