Healthcare Provider Details

I. General information

NPI: 1003019274
Provider Name (Legal Business Name): EMILY JOYCE GRANDUSKY MS, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 GLENMIL LN
ELLAMORE WV
26267-7020
US

IV. Provider business mailing address

165 GLENMIL LN
ELLAMORE WV
26267-7020
US

V. Phone/Fax

Practice location:
  • Phone: 304-997-2835
  • Fax:
Mailing address:
  • Phone: 304-997-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1054
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1054
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1054
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1054
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: