Individual
MRS. CAROLINE COULLETTE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAS
Contact information
Practice address
14 N CHURCH ST, MANNING, SC 29102-3502
(803) 435-2121
(803) 435-8856
Mailing address
14 N CHURCH ST, MANNING, SC 29102-3502
(803) 435-2121
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730176934
—
SC
Enumeration date
12/21/2012
Last updated
12/27/2012
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