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General NPI Number Information
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NPI Number | 1437773983
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Entity Type | Individual
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Provider Name | TE'ON GRANT
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Gender | Female
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Dates
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Enumeration Date | 06/01/2020
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Last Update Date | 06/01/2020
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Provider Practice Location Address
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Address Line | 89B OLD TROLLEY RD
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City | SUMMERVILLE
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State | SC
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Zip | 29485-4933
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Country | US
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Telephone | 843-425-2116
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Fax |
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Provider Business Mailing Address
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Address Line | 8684 HICKORY CREEK CT
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City | NORTH CHARLESTON
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State | SC
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Zip | 29420-6871
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Country | US
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Telephone | 843-442-1519
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7416
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License Number State | SC
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