Provider Demographics
NPI:1174288146
Name:GRANT, MARISSA CAREY (MA, LCMHCA, NCC)
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:CAREY
Last Name:GRANT
Suffix:
Gender:F
Credentials:MA, LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 CARMEL EXECUTIVE PARK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-0406
Mailing Address - Country:US
Mailing Address - Phone:704-752-8414
Mailing Address - Fax:704-544-1109
Practice Address - Street 1:7401 CARMEL EXECUTIVE PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-0406
Practice Address - Country:US
Practice Address - Phone:704-752-8414
Practice Address - Fax:704-544-1109
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health