Individual
CHARLES LATNEY GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
2303 E BURNSIDE ST, PORTLAND, OR 97214-1655
(503) 827-3644
Mailing address
2809 NE 21ST AVE, PORTLAND, OR 97212-3408
(503) 467-6366
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
09/30/2024
Last updated
09/30/2024
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