Individual
GRANTRINA ANTWUNET DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3433 BRAMBLETON AVE, ROANOKE, VA 24018-6515
(804) 562-9997
(757) 706-3550
Mailing address
3433 BRAMBLETON AVE, ROANOKE, VA 24018-6515
(804) 562-9997
(757) 706-3550
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0906014406
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236
—
DC
01
—
568946544
BCBS
—
Enumeration date
10/25/2025
Last updated
10/25/2025
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