Healthcare Provider Details

I. General information

NPI: 1285649061
Provider Name (Legal Business Name): VICTORIA V GRANTHAM MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GLENWAY ST SUITE B
BELMONT NC
28012-3173
US

IV. Provider business mailing address

100 GLENWAY ST SUITE B
BELMONT NC
28012-3173
US

V. Phone/Fax

Practice location:
  • Phone: 704-829-2005
  • Fax: 704-829-2006
Mailing address:
  • Phone: 704-829-2005
  • Fax: 704-829-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005362
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: