Individual
ELAINE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADAC
Contact information
Practice address
152 S HAMLETSBURG RD, BROOKPORT, IL 62910-2961
(615) 967-8978
Mailing address
152 S HAMLETSBURG RD, BROOKPORT, IL 62910-2961
(615) 967-8978
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LADAC
TN
Other
Enumeration date
03/30/2015
Last updated
03/30/2015
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