Healthcare Provider Details

I. General information

NPI: 1366331746
Provider Name (Legal Business Name): AUBREY ANNE GRANT MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 AIRPORT RD
WATERFORD MI
48327-1212
US

IV. Provider business mailing address

6116 BOROWY DR
COMMERCE TOWNSHIP MI
48382-3611
US

V. Phone/Fax

Practice location:
  • Phone: 734-224-3954
  • Fax:
Mailing address:
  • Phone: 248-867-8485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401225263
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: