Individual
MR. WILL WAYNE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSAC
Contact information
Practice address
607 BENSON RD, GARNER, NC 27529-3988
(919) 422-0104
(919) 934-2053
Mailing address
94 SWIFT CREEK RD, SMITHFIELD, NC 27577-9321
(919) 422-0104
(919) 934-2053
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22647
NCSAPPB
NC
Enumeration date
07/29/2016
Last updated
07/29/2016
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