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General NPI Number Information
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NPI Number | 1275955916
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Entity Type | Individual
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Provider Name | GRANTLIN SCHAFER LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 42785 GENERATION DR APT 514
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City | ASHBURN
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State | VA
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Zip | 20147-4091
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Country | US
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Telephone | 571-271-3681
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Fax |
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Provider Business Mailing Address
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Address Line | 42785 GENERATION DR APT 514
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City | ASHBURN
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State | VA
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Zip | 20147-4091
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Country | US
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Telephone | 571-271-3681
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Fax |
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0904008445
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904008445
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License Number State | VA
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