Individual
LILLIESHA GRANDBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2901 CORPORATE CIR, FLOWER MOUND, TX 75028-5625
(469) 396-6719
Mailing address
PO BOX 1129, #928, COPPELL, TX 75019-1129
(469) 396-6719
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
68093
TX
Other
Enumeration date
09/10/2014
Last updated
09/10/2014
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