Individual
KELSHAWN ANTHONY GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 12TH STREET EXT, PRINCETON, WV 24740-2329
(304) 425-9541
Mailing address
200 12TH STREET EXT, PRINCETON, WV 24740-2329
(304) 425-9541
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0005489001
WV
Other
Enumeration date
09/09/2024
Last updated
09/09/2024
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