MEDICARE: KASHEENA M GRINER LCSW

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
1	1041C0700X	Clinical Social Worker	CSW006324	GA

General Provider Information

NPI Number	:	1720580210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASHEENA M GRINER LCSW

Provider Business Mailing Address
First Line	:	3025 PEBBLE CREEK LANE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349
Country	:	US
Telephone Number	:	678-591-3232
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 PEBBLE CREEK LN
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-7952
Country	:	US
Telephone Number	:	678-591-3232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2018
Last Update Date	:	08/28/2019

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Directions to “ KASHEENA M GRINER LCSW” Practice Location

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