Individual
RENEE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2106 HOPE MILLS RD, FAYETTEVILLE, NC 28304-4226
(910) 460-6165
Mailing address
PO BOX 25247, FAYETTEVILLE, NC 28314-5004
(910) 460-6165
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
A9631
NC
101YP2500X
Professional Counselor
Primary
9631
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101Y00000X
—
NC
Enumeration date
03/05/2014
Last updated
03/08/2021
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