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General NPI Number Information
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NPI Number | 1205704970
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Entity Type | Individual
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Provider Name | GRANTRINA ANTWUNET DAVIS
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Gender | Female
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Dates
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Enumeration Date | 10/25/2025
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Last Update Date | 10/25/2025
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Provider Practice Location Address
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Address Line | 3433 BRAMBLETON AVE
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City | ROANOKE
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State | VA
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Zip | 24018-6515
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Country | US
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Telephone | 804-562-9997
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Fax | 757-706-3550
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Provider Business Mailing Address
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Address Line | 3433 BRAMBLETON AVE
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City | ROANOKE
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State | VA
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Zip | 24018-6515
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Country | US
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Telephone | 804-562-9997
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Fax | 757-706-3550
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0906014406
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License Number State | VA
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