Individual
MR. JORGE EDUARDO GRANDELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA/PSYD
Contact information
Practice address
79 E. WINDSOR BLVD, WINDSOR, VA 23487
(757) 242-9988
Mailing address
3930 SEEMAN RD, VIRGINIA BEACH, VA 23452-2457
(757) 498-8138
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710101723
VA
101YA0400X
Addiction (Substance Use Disorder) Counselor
0718000171
VA
101YM0800X
Mental Health Counselor
Primary
0701002347
VA
106H00000X
Marriage & Family Therapist
0717001060
VA
Other
Enumeration date
07/04/2006
Last updated
11/26/2007
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