Individual
GRANT CHARLES KIRKWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
158 W MAIN ST, ANDOVER, OH 44003-9318
(216) 353-4723
Mailing address
158 W MAIN ST, ANDOVER, OH 44003-9318
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
165555
OH
106S00000X
Behavior Technician
—
OH
175T00000X
Peer Specialist
Primary
000120
OH
Other
Enumeration date
03/13/2017
Last updated
12/05/2024
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