Individual
MR. DEWAYNE C GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
124 S MAIN ST, SUITE 2N, JONESBORO, GA 30236-3599
(678) 215-8705
(770) 898-4385
Mailing address
417 AKERS DR, MCDONOUGH, GA 30253-8382
(678) 215-8705
(770) 898-4385
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LPC 006829
GA
101YP2500X
Professional Counselor
Primary
LPC006829
GA
106H00000X
Marriage & Family Therapist
LPC 006829
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003152990A
—
GA
05
—
003160809A
—
GA
Enumeration date
08/09/2013
Last updated
08/03/2015
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