Individual
DESTINY GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CT
Contact information
Practice address
3094 W MARKET ST STE 105, FAIRLAWN, OH 44333-3617
(440) 260-8300
Mailing address
434 EASTLAND RD, BEREA, OH 44017-1217
(440) 234-2006
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
C.2103140-TRNE
OH
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
10/28/2021
Last updated
11/03/2022
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