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General NPI Number Information
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NPI Number | 1598333957
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Entity Type | Individual
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Provider Name | JAMES EDWARD GRANBERRY LCSWA
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Gender | Male
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 135 W 10TH ST
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City | CHARLOTTE
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State | NC
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Zip | 28202-2229
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Country | US
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Telephone | 704-626-3994
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Fax |
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Provider Business Mailing Address
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Address Line | 135 W 10TH ST
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City | CHARLOTTE
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State | NC
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Zip | 28202-2229
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Country | US
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Telephone | 704-626-3994
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P15053
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License Number State | NC
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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 | P015053
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License Number State | NC
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