Individual
ANISA D GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, NCAC
Contact information
Practice address
613 TOWNE PARK DR W STE 103, RINCON, GA 31326-9098
(912) 826-0918
(912) 826-0959
Mailing address
613 TOWNE PARK DR W STE 103, PO BOX 1834, RINCON, GA 31326-9098
(912) 826-0918
(912) 826-0959
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
GA
101YP2500X
Professional Counselor
Primary
004189
GA
Other
Enumeration date
01/31/2007
Last updated
07/14/2015
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