Healthcare Provider Details

I. General information

NPI: 1275955916
Provider Name (Legal Business Name): GRANTLIN SCHAFER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42785 GENERATION DR APT 514
ASHBURN VA
20147-4091
US

IV. Provider business mailing address

42785 GENERATION DR APT 514
ASHBURN VA
20147-4091
US

V. Phone/Fax

Practice location:
  • Phone: 571-271-3681
  • Fax:
Mailing address:
  • Phone: 571-271-3681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0904008445
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008445
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: