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General NPI Number Information
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NPI Number | 1760896575
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Entity Type | Individual
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Provider Name | AYANA UTAMU GRANT LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 10/30/2022
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Provider Practice Location Address
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Address Line | 530 N ST SW APT S408
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City | WASHINGTON
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State | DC
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Zip | 20024-4559
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Country | US
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Telephone | 240-406-7606
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Fax |
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Provider Business Mailing Address
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Address Line | 530 N ST SW APT S408
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City | WASHINGTON
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State | DC
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Zip | 20024-4559
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Country | US
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Telephone | 240-406-7606
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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 | CW018038
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License Number State | PA
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