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Individual

GRANT GERARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW, LAC

Contact information

Practice address
3909 NEW VISION DR, FORT WAYNE, IN 46845
(260) 373-8000
(260) 373-8034
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34007989A
IN

Other

Enumeration date
12/05/2017
Last updated
08/06/2021
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