Individual
AUTUMN GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10102 COUNTRY CLUB RD SE, CUMBERLAND, MD 21502-8339
(301) 777-2285
Mailing address
10102 COUNTRY CLUB RD SE, CUMBERLAND, MD 21502-8339
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCA3103
MD
101YP2500X
Professional Counselor
Primary
LC12969
MD
Other
Enumeration date
06/17/2024
Last updated
06/17/2024
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