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DAVID GRANDCOLAS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPC

Contact information

Practice address
700 AIRPORT ROAD, PREFERRED BEHAVIORAL HEALTH OF NJ, LAKEWOOD, NJ 08701
(732) 367-4700
(732) 785-9500
Mailing address
81 WILSON AVE, NEPTUNE CITY, NJ 07753
(732) 775-8984

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
37PC00341900
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0029807
NJ
01
526788
AGENCY MEDICARE NUMBER
NJ
Enumeration date
01/28/2009
Last updated
01/28/2009
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