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NPI Code Detail

MEDICARE: LATONYA GRANT MAC, CSAC, SAP, QMHP

MEDICARE: LATONYA GRANT MAC, CSAC, SAP, QMHP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor0710102076VA

General Provider Information

NPI Number : 1346088275
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATONYA GRANT MAC, CSAC, SAP, QMHP
Provider Business Mailing Address
First Line : 2856 FOREHAND DR
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23323-2006
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2856 FOREHAND DR
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23323-2006
Country : US
Telephone Number : 757-705-5025
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2024
Last Update Date : 07/16/2024

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