Healthcare Provider Details

I. General information

NPI: 1063331429
Provider Name (Legal Business Name): MICHAELA GRANT EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 PINNACLE POINT DR STE 120
COLUMBIA SC
29223-5740
US

IV. Provider business mailing address

1021 PINNACLE POINT DR STE 120
COLUMBIA SC
29223-5740
US

V. Phone/Fax

Practice location:
  • Phone: 803-722-4008
  • Fax:
Mailing address:
  • Phone: 803-722-4008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12393
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: