Individual
MARK GRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12640 CORONA BOREALIS, SAN ANTONIO, TX 78245-4861
(830) 225-1622
Mailing address
12640 CORONA BOREALIS, SAN ANTONIO, TX 78245-4861
(830) 225-1622
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17557
TX
Other
Enumeration date
06/01/2026
Last updated
06/01/2026
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