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General NPI Number Information
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NPI Number | 1376573469
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Entity Type | Individual
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Provider Name | JORGE EDUARDO GRANDELA MA/PSYD
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Gender | Male
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 79 E. WINDSOR BLVD
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City | WINDSOR
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State | VA
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Zip | 23487
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Country | US
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Telephone | 757-242-9988
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Fax |
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Provider Business Mailing Address
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Address Line | 3930 SEEMAN RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-2457
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Country | US
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Telephone | 757-498-8138
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710101723
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0718000171
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701002347
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717001060
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License Number State | VA
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