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General NPI Number Information
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NPI Number | 1245873710
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Entity Type | Individual
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Provider Name | JONHA-VIRGINIA GRANT
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Gender | Female
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Dates
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Enumeration Date | 10/28/2019
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 3214 WINCHESTER
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City | BENTON
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State | AR
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Zip | 72015-2929
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Country | US
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Telephone | 501-794-6482
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Fax | 501-794-6483
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Provider Business Mailing Address
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Address Line | 3214 WINCHESTER
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City | BENTON
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State | AR
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Zip | 72015-2929
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Country | US
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Telephone | 501-794-6482
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Fax | 501-794-6483
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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