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General NPI Number Information
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NPI Number | 1467968057
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Entity Type | Individual
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Provider Name | CAROLYN WILLIAMS GRANT MSW,PCMHT
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Gender | Female
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 12/19/2017
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Provider Practice Location Address
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Address Line | 1654 E UNION ST
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City | GREENVILLE
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State | MS
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Zip | 38703-3250
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Country | US
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Telephone | 662-335-5274
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Fax | 662-378-3976
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Provider Business Mailing Address
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Address Line | 2504 BROWNING ROAD 520
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City | GREENWOOD
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State | MS
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Zip | 38930-6022
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Country | US
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Telephone | 662-332-5274
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Fax | 662-378-3976
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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 | PH4056
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License Number State | MS
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