Individual
MR. CHARLES R GRANHOLM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
200 BRULE ST BLDG IRELAND, FORT KNOX, KY 40121-6100
(502) 626-9885
Mailing address
200 BRULE ST BLDG 871, FORT KNOX, KY 40121-6100
(502) 626-9877
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1308
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1308
STATE LICENSE
KY
01
—
34004318A
STATE LICENSE
IN
Enumeration date
12/16/2005
Last updated
12/04/2023
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